The risk of metabolic syndrome in women with previous GDM in a long-term follow-up

Abstract

The aim of this study was to evaluate the incidence of metabolic syndrome (MetS) during long-term follow-up of women with gestational diabetes (GDM). Furthermore, we evaluated the glycemic measures from an oral glucose tolerance test (OGTT) during pregnancy as predictors of incident MetS. Women diagnosed with GDM were divided into two groups according to the results of OGTT: one abnormal value = GDM1 (n = 338) and two abnormal values = GDM2 (n = 151), while women with normal glucose tolerance (n = 385) served as controls. MetS and its components were evaluated in a follow-up study (mean follow-up time 7.3 ± 5.1 years) according to the International Diabetes Federation (IDF) criteria. Fasting plasma glucose in OGTT was the best predictor of incident MetS in ROC (area under the curve) analysis. The incidence of MetS during a <5-year follow-up was 22.2% in controls, 39.3% in GDM1 and 60.4% in GDM2; and >10-year follow-up 24.2%, 46.2% and 62.5%, respectively. In controls and GDM2, the incidence of MetS remained nearly constant during the follow-up, whereas in GDM1 it increased. In conclusion, already mild gestational glucose intolerance may progress to MetS and therefore merits intervention measures to prevent future cardiovascular disease.

Chinese abstract

本研究的目的是评估患妊娠期糖尿病 (GDM)的妇女在长期随访中代谢综合征 (MetS)的发病率。此外, 我们通过口服葡萄糖耐量试验 (OGTT) 评估了孕期的血糖值, 作为MetS发病的相关因素。根据OGTT结果将诊断为GDM的女性分成两组: 一个异常值=GDM1 (n = 338) 和两个异常值=GDM2 (n = 115) , 葡糖糖耐量正常的女性 (n = 385) 作为对照组。依据国际糖尿病联合会 (IDF) 标准在随访研究 (平均随访时间: 7.3 ± 5.1年) 中评估MetS及其主要内容。在ROC (曲线下面积) 分析中, OGTT中的空腹血糖是MetS发生的最相关因素。通过小于5年的随访, 对照组MetS的发生率是22.2%, GDM1组MetS的发生率是39.3%, GDM2组MetS的发生率是60.4%；大于10年的随访, 对照组、GDM1组和GDM2组MetS的发生率分别是24.2%、46.2%和62.5%。随访过程中, 对照组和GDM2组MetS的发生率几乎保持不变。但是, GDM1组MetS的发生率却升高了。总之, 先前轻度的妊娠期葡萄糖耐受不良可能会向MetS发展。因此, 要采取干预措施来预防远期心血管疾病。

Keywords:

• Gestational diabetes
• metabolic syndrome
• oral glucose tolerance test

Declaration of interest

None of the authors have a conflict of interest. The authors alone are responsible for the content and writing of the paper.

This study was supported by the Finnish Cultural Foundation, North Savo Regional Fund and EVO grant from the Kuopio University Hospital.