Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus

Joon Ho Moon, Soo Heon Kwak, Hak C Jang, Joon Ho Moon, Soo Heon Kwak, Hak C Jang

Abstract

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.

Keywords: Clinical trial; Diabetes mellitus, type 2; Diabetes, gestational; Epidemiology; Risk factors.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Cumulative incidence of type 2 diabetes after gestational diabetes mellitus pregnancy. CI, confidence interval. Adapted from Kwak et al. [36], with permission from Endocrine Society.
Figure 2.
Figure 2.
Genetic risk factors for early (≤ 8 weeks) and late (> 1 year) conversion to postpartum diabetes. ap value < with the signif icance after Bonferroni correction (0.05/10/2 = 0.0025).
Figure 3.
Figure 3.
Changes in insulin sensitivity (Matsuda index) and insulin secretory function (insulinogenic index) according to postpartum body mass index (BMI) change during 4 years of follow-up. Changes in insulin sensitivity and secretory function by tertiles of postpartum BMI change were depicted (open circle, initial postpartum visit; closed circle, last follow-up). Subjects in the first tertile (who lost weight during follow-up) showed improvements in both insulin sensitivity and insulin secretion, whereas subjects in the third tertile (who gained weight during follow-up) had significant deterioration in insulin sensitivity but were not able to compensate by increasing their insulin secretion during follow-up. Adapted from Moon et al. [45], with permission from Endocrine Society.

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