Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the 1st Three Years Postdelivery. The St Carlos Gestational Diabetes Mellitus Prevention Cohort

Arnoriaga-Rodriguez, M.; Melero, V.; Barabash, A.; Valerio, J.; del Valle, L.; O’Connor, R.M.; de Miguel, P.; Diaz, J.A.; Familiar, C.; Moraga, I.; Duran, A.; Jimenez, I.; Cuesta, M.; Torrejon, M.J.; Martinez-Novillo, M.; Runkle, I.; Pazos, M.; Rubio, M.A.; Matia-Martín, P.; Calle-Pascual, A.L. Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort. Nutrients 2023, 15, 4995. Arnoriaga-Rodriguez, M.; Melero, V.; Barabash, A.; Valerio, J.; del Valle, L.; O’Connor, R.M.; de Miguel, P.; Diaz, J.A.; Familiar, C.; Moraga, I.; Duran, A.; Jimenez, I.; Cuesta, M.; Torrejon, M.J.; Martinez-Novillo, M.; Runkle, I.; Pazos, M.; Rubio, M.A.; Matia-Martín, P.; Calle-Pascual, A.L. Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort. Nutrients 2023, 15, 4995.

Abstract

Objective: To identify risk factors(RF) related to abnormal glucose regulation(AGR) 3 years postpartum according to 3-month-postpartum glucose status. Research design: Normoglycemic pregnant women of the St. Carlos Gestational Study included before gestational week 12, during 2015-2017. Of 3,036 eligible women, 2529 were followed-up until delivery: 1400 participated in postpartum follow-up. AGR defined as fasting serum glucose (FSG)>5.6 mmol/L and/or HbA1c >5.7% (39 mmol/mol) and/or 2h-SG ≥140/mg/dL after 75-g OGTT. 12-modifiable and 3-unmodifiable RF were analyzed for associations with glycemic changes. Reinforcement of Mediterranean Diet adherence was provided to all women at the postpartum visit by a dietitian Results: 137/1400(9.8%) women presented AGR 3 years postpartum, 27/137(19.7%) also had at 3 months, whereas 110/137(80.2%) had not. The remaining 1,263(90.2%) women were normoglycemic 3 years postpartum, 1180/1263(84.3%) were at 3 months, while 83/1263(6.08%) had AGR and became normoglycemic. Women with GDM were more likely to progress to AGR 3 years postpartum (OR:1.60[1.33-1.92]) and less likely to remain normoglycemic (OR:0.22[0.15-0.33]) versus non-GDM women. Having >2/3 unmodifiable RF was associated with a reduced rate of maintained normoglycemia (OR:0.56[0.39-0.80]) and an increased risk of progression to AGR (OR:1.90[1.28-2.83]). Having >5/12 modifiable RF was associated with a reduced rate of maintained normoglycemic (OR:0.74[0.51-0.99]) and reversion of AGR (OR:0.49[0.25-0.97]), an increased progression to AGR (OR:1.40[1.00-2.09]), and persistence of AGR (OR:2.57[1.05-6.31]). Pre-gestational BMI≥25kg/m2 (OR:1.80[1.19-2.71]), post-delivery weight gain (OR:2.22[1.10-4.48]), and waist circumference >89.5cm (OR:0.54[0.36-0.79]), (all p<0.05) were the main modifiable RF. Conclusions: RF related to an increased probability for 3-year-postpartum AGR despite 3-month normoglycemia were identified, potentially useful when designing personalized strategies for pregnant women, directed towards minimizing unfavorable outcomes.

Keywords

Pregnancy; Prediabetic State; Abnormal Glucose Regulation; Postpartum; Glucose Intolerance

Subject

Public Health and Healthcare, Public Health and Health Services

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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