Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study
Angela Napoli, Laura Sciacca, Basilio Pintaudi, Andrea Tumminia, Maria Grazia Dalfrà, Camilla Festa, Gloria Formoso, R. Fresa, Giusi Graziano, Cristina Lencioni, Antonio Nicolucci, Maria Chiara Rossi, Elena Succurro, Maria Angela Sculli, Marina Scavini, Ester Vitacolonna, Matteo Bonomo, Elisabetta Torlone, the STRONG Study Collaborators and the AMD-SID Diabetes and Pregnancy Study Group, Angela Napoli, Olimpia Bitterman, Camilla Festa, Chiara Giuliani, Matteo Bonomo, Basilio Pintaudi, Elena Cimino, Elena Mion, Teresa Marcone, Cristina Lencioni, Graziano Di Cianni, Laura Sciacca, Andrea Tumminia, Agostino Milluzzo, Ester Vitacolonna, Federica Fraticelli, Marica Franzago, Alessandro Roberto Dodesini, Elena Ciriello, Mariagrazia Dalfrà, Annunziata Lapolla, Raffaella Fresa, Aurora Grassi, Paolo Limone, Annamaria Nuzzi, Andi Masha, Laura Grimaldi, Sara Biglino, E Ansaldi, Maurizia Battezzati, Giancarla Meregalli, Valentina De Mori, D. Berzi, Antonio Bossi, Viviana Baggi, Elisabetta Lovati, Lara Quarleri, Tiziana Romanelli, Silvia Clementi, Ilaria Nicolao, Francesca Zambotti, Simonetta Lombardi, Silvana Costa, Chiara Tommasi, Silvia Rancan, G. Lisato, Paola Bordón, Daniela Turazzi, Francesco Mollo, Franco Grimaldi, Laura Tonutti, Sandra Agus, Maria Rosaria Falivene, Giorgio Versari, Laura Corsi, Maria Delucchi, Luisa Ratto, Maria Grazia Magotti, T. Frusca, Silvia Haddoub, Alice Suprani, Mary Mori, Maria Grazia Vita, Nicolina Di Biase, Alessandra Bertolotto, Michele Aragona, Cristina Bianchi, Emilia Lacaria, Elisa Guarino, Federica Monaci, Francesco Dotta, Elisabetta Torlone, Carlo Lalli, Chiara Di Loreto, Maura Scarponi, Angela Del Prete, Sergio Leotta, Iolanda Coletta, Santina Abbruzzese, Valeria Montani, Emanuela Cannarsa
Abstract
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/m 2 ). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m 2 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.