Women with gestational diabetes mellitus (GDM) face a substantially increased risk of subsequent diabetes, according to a study published in Diabetes Care .
Katharine J. McCarthy, Ph.D., MPH, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues estimated racial and ethnic differences in the influence of GDM on diabetes risk and glycemic control. The analysis included a final birth cohort of 336,276 women (2009 to 2017).
The researchers found that the cumulative incidence of diabetes was 11.8 percent for women with GDM and 0.6 percent among women without GDM. The risk of diabetes with GDM was more than 11 times higher overall (adjusted hazard ratio, 11.5), with slight differences observed by race and ethnicity.
Additionally, GDM was associated with a lower likelihood of glycemic control (adjusted hazard ratio, 0.85), with higher risk among black women (adjusted hazard ratio, 0.77) and Hispanic women (adjusted hazard ratio, 0.77). adjusted risk, 0.84).
"Our findings highlight the importance of regular diabetes screening after gestational diabetes, particularly in the first 12 months postpartum, which was marked by the highest incidence of diabetes and the lowest likelihood of glycemic control, to facilitate early detection and proper control of diabetes," McCarthy said in a statement. "In addition to care coordination between obstetric and primary care providers, educating providers about the importance of obstetric history taking is essential to facilitate diabetes awareness and early glycemic control."
Summary
Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Population-Based Retrospective Cohort
Aim
Racial/ethnic-specific estimates of the influence of gestational diabetes mellitus (GDM) on type 2 diabetes remain unexplored in large population-based cohorts. We estimated racial/ethnic differences in the influence of GDM on diabetes risk and glycemic control in a multiethnic, population-based cohort of postpartum women.
Design and methodology
Hospital discharge and vital registration data for births in New York City (NYC) between 2009 and 2011 were linked to data from the NYC A1C Registry between 2009 and 2017. Women with baseline diabetes (n = 2810) were excluded. from a final birth cohort of 336,276.
Gestational diabetes mellitus (GDM) in time for diabetes onset (two A1C tests of ≥6.5% starting at 12 weeks postpartum) or glucose control (first A1C test <7, 0% after diagnosis) was assessed using Cox regression with time-varying exposure. Models were adjusted for sociodemographic and clinical factors and stratified by race/ethnicity.
Results
The cumulative incidence of diabetes was 11.8% and 0.6% among women with and without GDM. The adjusted hazard ratio (aHR) of GDM status on diabetes risk was 11.5 (95% CI: 10.8, 12.3) overall, with slight differences by race/ethnicity. GDM was associated with a lower likelihood of glycemic control (aHR 0.85; 95% CI 0.79, 0.92), with the greatest negative influence among blacks (aHR 0.77; 95% CI 0.79, 0.92). 68, 0.88) and Hispanic (aHR 0.84; 95% CI 0.74, 0.95) women.
Adjustment for detection bias and loss to follow-up modestly attenuated racial/ethnic differences in diabetes risk but had little influence on glycemic control.
Conclusions
Understanding racial/ethnic differences in the influence of GDM on diabetes progression is critical to disrupting life course cardiometabolic disparities.
