Predictive factors of type 2 diabetes and prediabetes diagnosis in women with gestational diabetes

Lopes Marta Vaz; Rocha Jose Vicente; Carolina Peixe; Grine Severino Mariana de; Lopes Catarina Isabel; Duarte Miguel Antonio; Valente Maria Pulido; Alexandre Maria Ines; Ana Gomes; Bugalho Maria Joao

doi:10.1530/endoabs.110.P423

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Endocrine Abstracts (2025) 110 P423 | DOI: 10.1530/endoabs.110.P423

ECEESPE2025 Poster Presentations Diabetes and Insulin (143 abstracts)

Predictive factors of type 2 diabetes and prediabetes diagnosis in women with gestational diabetes

Marta Vaz Lopes¹, José Vicente Rocha^{1, 2}, Carolina Peixe^{1, 2}, Mariana de Griné Severino¹, Catarina Isabel Lopes¹, Miguel António Duarte¹, Maria Pulido Valente³, Maria Inês Alexandre^{1, 2}, Ana Gomes^{1, 2} & Maria João Bugalho^{1, 2}

Author affiliations

¹Serviço de Endocrinologia, Diabetes e Metabolismo - Hospital de Santa Maria, Lisbon, Portugal; ²Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; ³Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução - Hospital de Santa Maria, Lisbon, Portugal

JOINT1966

Introduction: Women with gestational diabetes (GD) are at increased risk of developing type 2 diabetes (T2D), and 20-33% of them are diagnosed with either prediabetes or T2D immediately postpartum. Therefore, a postpartum 75g oral glucose tolerance test (75g-OGTT) is recommended for all women with GD.

Aims: To identify predictive factors for postpartum diagnosis of T2D or prediabetes in women with GD.

Methods: This retrospective study included all women diagnosed with GD that delivered at a tertiary center from 2019 to 2023. Logistic regression models were used to evaluate associations between abnormal postpartum 75g-OGTT and demographic and clinical characteristics.

Results: Of 700 women with GD, only 318 (45. 4%) attended their scheduled postpartum 75g-OGTT, while 54. 6% missed their appointments. Higher age [OR (odds ratio) 1. 07, 95%CI (95% confidence interval) 1. 05-1. 1, P < 0. 001] and higher education levels (OR 1. 56, 95%CI 1. 35-1. 8, P < 0. 001) were identified as predictors of postpartum OGTT attendance. Among the 318 women who completed testing, 259 (81. 4%) had normal results, and 59 (18. 6%) had abnormal results, with 13 diagnosed with T2D and 46 with prediabetes. The identified predictors of abnormal postpartum 75g-OGTT were:

• Higher HbA1c levels during pregnancy (3rd trimester HbA1c: OR 3. 72, 95%CI 1. 89-7. 33, P < 0. 001; average HbA1c: OR 3. 98, 95%CI 2. 02-7. 86, P < 0. 001);

• Requirement of pharmacological treatment for GD control (OR 2. 86, 95%CI 1. 55-5. 29, P < 0. 001). A subanalysis of only the pharmacologically treated GD cases showed that treatment with both insulin and metformin further increased postpartum prediabetes/T2D risk, vs treatment with insulin or metformin alone (OR 2. 33, 95%CI 1. 11-4. 91, P = 0. 03);

• Higher plasma glucose levels at GD diagnosis (fasting plasma glucose levels: OR 1. 04, 95%CI 1. 02-1. 05, P < 0. 001; 1-hour plasma glucose levels of diagnostic OGTT: OR 1. 014, 95%CI 1. 003-1. 03, P = 0. 014; 2-hour plasma glucose levels of diagnostic OGTT: OR 1. 011, 95%CI 1. 001-1. 021, P = 0. 035).

Other evaluated factors were not predictive of abnormal postpartum 75g-OGTT Results age, parity, positive family history of T2D, positive personal history of GD, pre-pregnancy BMI, weight gain during pregnancy or trimester of GD diagnosis.

Conclusion: This study showed that HbA1c levels during pregnancy, GD pharmacological treatment requirement and plasma glucose levels at GD diagnosis were predictors of abnormal postpartum 75g-OGTT in women with GD. These factors should be considered in order to optimize GD management strategies. Additionally, similarly to what is described in the literature, over half of women with GD did not attend their postpartum OGTT appointments, highlighting the need for interventions to improve adherence.