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- Title
Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study.
- Authors
Napoli, Angela; Sciacca, Laura; Pintaudi, Basilio; Tumminia, Andrea; Dalfrà, Maria Grazia; Festa, Camilla; Formoso, Gloria; Fresa, Raffaella; Graziano, Giusi; Lencioni, Cristina; Nicolucci, Antonio; Rossi, Maria Chiara; Succurro, Elena; Sculli, Maria Angela; Scavini, Marina; Vitacolonna, Ester; Bonomo, Matteo; Torlone, Elisabetta; the STRONG Study Collaborators and the AMD-SID Diabetes and Pregnancy Study Group; Bitterman, Olimpia
- Abstract
Aims: To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Methods: Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. Results: From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. Conclusions: Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.
- Subjects
GESTATIONAL diabetes; PUERPERIUM; GLUCOSE tolerance tests; RECURSIVE partitioning; SCIENTIFIC observation; DIABETES; BODY mass index; BIRTH weight
- Publication
Acta Diabetologica, 2021, Vol 58, Issue 9, p1187
- ISSN
0940-5429
- Publication type
Article
- DOI
10.1007/s00592-021-01707-9