Endocrine Abstracts

Introduction: Gestational diabetes mellitus (GDM) is a risk factor for maternal-fetal complications and development of diabetes or intermediate hyperglycemia after pregnancy. The follow-up should be done by a multidisciplinary team. After delivery, all women diagnosed with GDM should undergo an oral glucose tolerance test (OGTT) for reclassification

Aim: To evaluate the non-adherence factors to reclassification OGTT after GDM.

Methods: A cohort of 5271 Portuguese women from the National Registry of GDM was studied. Demographic, anthropometric and analytical data and maternal-fetal outcomes were evaluated. The diagnosis of DGM was made according to WHO criteria.

Results: In our sample, 1666 (31.5%) women with DGM did not undergo reclassification OGTT. Of those who underwent OGTT, 92.2% had a normal test, 0.9% diabetes and 6.9% intermediate hyperglycemia. The chance of follow-up loss was 46.5% higher in women below 30 year-old (OR=1.465, 95% CI=1.294–1.660, P<0.001) and 40.9% higher in those with ≥3 pregnancies (OR=1.409, 95%CI=1.243–1.599, P<0.001). Women treated with insulin during pregnancy had increased adherence to the reclassification test (OR=1.377, 95% CI=1.222–1.552, P<0.001), but those with worse glycemic control with HbA1c≥5.7% in 3^rd trimester had 60% more chance of follow-up loss (OR=1.608, 95% CI=1.318–1.962, P<0.001). The adherence to postpartum reclassification was also significantly lower when there was fetal (OR=5.085, 95% CI=2.402–10.763, P<0.001) or neonatal (OR=4.661, 95% CI=1.365–16.055, P=0.013) death. Age, number of pregnancies, HbA1c in the 3rd trimester and insulin treatment remained statistically significant in the multivariate analysis.

Conclusion: Younger women, with a higher number of pregnancies, worse glycemic control and fetal/neonatal mortality associated with pregnancy appear to be more likely to lose the follow-up. Given the risk of diabetes after pregnancy, we should emphasize the need for OGTT reclassification in the puerperium and define strategies to promote their accomplishment.