ESPE Yearbook of Paediatric Endocrinology

Diabetes Care. 2022 Apr 1;45(4):864-870. doi: 10.2337/dc21-1430. PMID: 35104325.

Brief Summary: This study followed up a nationwide cohort of pregnant women (with and without gestational diabetes, GDM) and assessed their risk of developing type 2 diabetes mellitus up to 10 years later. The risk of developing type 2 diabetes increased with the number of GDM pregnancies.

About 6% of pregnancies are affected by GDM, and women with GDM have increased risk of later type 2 diabetes (T2D). A meta-analysis estimated that the risk for later T2D among women with GDM is 10-fold higher compared with non-GDM women (1). However, it is unclear if this risk of T2D depends on the number of affected pregnancies or for how long the risk persists.

These authors followed up a nationwide cohort of women over a 10-year period after pregnancy and assessed how the risk of T2D varies with BMI and the cumulative number of GDM pregnancies, and how the age-specific relative risk of T2D changes over time. A history of GDM predicted greatly increased rates of developing T2D. The relative risk increased substantially with each additional GDM pregnancy. Women with > 3 GDM pregnancies who were within 6–15 years of their last GDM pregnancy had ~ 7-fold higher risk of T2D compared with those without GDM. In addition, although the age-adjusted relative risk of T2D declined over time since the most recent GDM diagnosis, it remained elevated for >35 years.

How might GDM increase the risk of later T2D? The precise reasons for this are unclear, but GDM leads to pancreatic beta-cell dysfunction in women with pre-existing insulin resistance and this might be progressive (2). In addition, GDM itself may have deleterious effects on beta-cell function.

These observations have important clinical implications as women with GDM should be screened regularly for T2D, especially those with multiple GDM pregnancies. Additionally, women with a history of GDM who also have a BMI in the overweight or obese category, should be screened regularly for T2D, even late in life.

References: 1. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 2020;369:m1361. 2. Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent type 2 diabetes among U.S. women. Diabetes Res Clin Pract 2018;141: 200–208.