Incidence of Postpartum Diabetes and Glucose Intolerance among Filipino Patients with Gestational Diabetes Mellitus seen at a Tertiary Hospital
Abstract
Objective. Women with gestational diabetes mellitus (GDM) are at increased risk to develop type 2 diabetes. This study aims to determine the incidence of postpartum diabetes and/or glucose intolerance among Filipino GDM patients who delivered at a tertiary hospital in Manila and to compare the risk factors present among these women.
Methodology. 173 Filipino patients were included in this 3-year prospective cohort study. Demographics, clinical variables, and feto-maternal outcomes were recorded. 124 patients returned for follow-up and postpartum glycemic status was determined using 75g oral glucose tolerance test.
Results. The incidence of diabetes and prediabetes postpartum was 7.3% and 34.7% respectively. Logistic regression analysis showed that multigravid patients (OR=2.84; 95% CI 1.20,6.70) and those with postpartum obesity (OR=2.84; 95% CI 1.20,6.70) are more likely to have prediabetes. Diagnosis of GDM at an earlier trimester increases the odds of having postpartum diabetes (OR=3.05; 95% CI 1.02,9.18). Also, if the body mass index falls under obese class II postpartum, the probability increases 115 times (95% ci 3.96,3357.83; p=0.006).
Conclusion. The incidence of postpartum glucose intolerance among Filipino women with GDM is high. Clinicians should be more vigilant and strategies to implement compliance to postpartum glucose testing must be formulated to increase rates of follow-up testing among these women.
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References
Friedman J, Kirwan J, Jing M, Presley L, Catalano P. Increased skeletal muscle tumor necrosis factor-α and impaired insulin signaling persist in obese women with Gestational Diabetes Mellitus 1 year postpartum. Diabetes. 2008; 57(3):606-613.
Lee AJ, Hiscock RJ, Wein PW, Walker SP, Permezel M. Gestational Diabetes Mellitus: Clinical predictors and long-term risk of developing Type 2 diabetes: A retrospective cohort study using survival analysis. Diabetes Care. 2007; 30(4):878-883.
Litonjua AD, Waspadji S, Pheng CS, et al. AFES study group on diabetes in pregnancy preliminary data on prevalence. Phil J Internal Medicine. 1996; 34: 67-68.
Lim-Uy SW, Cunanan EC, Andag-Silva AA. Prevalence and risk factors of Gestational Diabetes Mellitus at the University of Santo Tomas Hospital. Phil J Internal Medicine. 2010; 48(1):24-31.
Buchanan T, Xiang A: Gestational Diabetes Mellitus. J Clin Invest. 2005; 115(3):485-491.
Rivas A, Gonzalez N, Gonzalez J. High frequency of diabetes in early post-partum assessment of women with gestational diabetes mellitus. Diabetes Metab Syndr Clin Res Rev. 2007; 1:159-165.
Metzger ED, Buchanan TA, Coustan DR, et al. American Diabetes Association: Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007; 30(Supp 2):s251-s260.
Kim C, Newton K, Knopp R. Gestational Diabetes and the incidence of Type 2 diabetes. Diabetes Care. 2002; 25(10):1862-1868.
Ko G, Chan J, Tsang L, Li C, Cockram C. Glucose intolerance and other cardiovascular risk factors in Chinese women with a history of Gestational Diabetes Mellitus. Aust N Z J Obstet Gynaecol. 1999; 39(4):478-483.
Lauenborg J, Hansen T, Jensen DM, et al: Increasing incidence of diabetes after Gestational Diabetes. Diabetes Care. 2004; 27(5):1194-1199.
American Diabetes Association: Gestational Diabetes Mellitus. Diabetes Care. 2004; 27(Supp 1):S88-90.
Hunt K, Conway DL. Who returns for postpartum glucose screening following Gestational Diabetes Mellitus? Am J Obstet Gynecol 2008; 198(4): 404:e1-6.
Solimen D, Isip-Tan I. Abnormal glucose tolerance and metabolic syndrome among Filipino women with previous Gestational Diabetes Mellitus. 2006. Unpublished manuscript, University of the Philippines-Philippine General Hospital.
Kanazawa M, Yoshiike N, Osaka T, et al. Criteria and classification of obesity in Japan and Asia-Oceania. Asia Pacific Journal of Clinical Nutrition 2002; 11(s8): 732-737
Jang H, Yim C, Han K, et al. Gestational Diabetes mellitus in Korea: Prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract. 2003; 61(2):117-124.
Lin CH, Wen SF, Wu YH, Huang YY, Huang MJ: The postpartum metabolic outcome of women with previous Gestational Diabetes Mellitus. Chang Gung Med J. 2005; 28(11):794-800.
Ogonowski J, Miazgowski T. The prevalence of 6 weeks postpartum abnormal glucose tolerance in Caucasian women with gestational diabetes. Diabetes Res Clin Pract. 2009; 84(3):239-244.
Lobner K, Knoptf A, Baumgarten A, et al. Predictors of postpartum diabetes in women with Gestational Diabetes Mellitus. Diabetes. 2006; 55(3):792-797.
Krishnaveni G, Hill J, Veena S, et al. Gestational Diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women. Diabetes Res Clin Pract. 2007; 78(3):398-404.
Steinhart JR, Sugarman JR, Connell FA: Gestational diabetes is a herald of NIDDM in Navajo women. High rate of abnormal glucose tolerance after GDM. Diabetes Care. 1997; 20(6):943-947.
O’Sullivan JB. Subsequent morbidity among GDM women: Carbohydrate metabolism in pregnancy and the newborn. New York, Churchill Livingstone 1984.
Pallardo F, Herranz L, Garcia I: Early postpartum metabolic assessment in women with prior Gestational Diabetes. Diabetes Care. 1999; 22(7):1053-1058.
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