Postpartum carbohydrate metabolism, metabolic syndrome and cardiovascular risk factors in gestational diabetes mellitus

Women with a history of gestational diabetes mellitus (GDM) are at increased risk for developing diabetes in their later lives. Previous GDM has been reported to be associated with increased prevalence of metabolic syndrome, a constellation of risk factors leading to cardiovascular disorders. In this prospective case-control study, we aimed to determine the predictors of subsequent development of postpartum carbohydrate intolerance and diabetes in women with GDM. We also attempted to evaluate the development of the metabolic syndrome and cardiovascular risk factors.Two hundred fifth-two consecutive women with GDM were enrolled. After exclusion of women who did not attend to the hospital for follow-up visits for minimum one year, data of 195 patients were evaluated. Seventy-one lean women with negative screening for GDM were included as a control group.After a mean follow-up of 3.39 years, the prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose were found to be 13.8%, 22.6%, and 29.3% among previous GDM women and 0%, 0%, and 2.8% among controls, respectively (p < 0.001). Metabolic syndrome prevalence was significantly higher in women with previous GDM. Women with previous GDM were more insulin resistant, had an atherogenic lipid profile and increased carotid intima media thickness. Postpartum diabetes was found much more frequently among women who had been treated with insulin during pregnancy compared to those who had received medical nutrition. Multiple logistic regression analysis showed that fasting and 1.h post-load blood glucose during the diagnostic oral glucose tolerance test were independent predictors of the subsequent development of diabetes in the postpartum state.Our data showed that women with previous GDM are at high risk for developing carbohydrate metabolism disturbance, metabolic syndrome and atherosclerosis. In conclusion, we suggest that early prediction of the subsequent development of postpartum carbohydrate intolerance is possible, and seems to be vital to prevent cardiovascular disorders.