Prevalence of diabetes five years after having gestational diabetes during pregnancy — Croatian national study

Published:March 06, 2018DOI:https://doi.org/10.1016/j.pcd.2018.02.003

      Highlights

      • Prevalence of diabetes 5 years after pregnancy with gestational diabetes in Croatia is 3.75%.
      • Medical birth certificates and CroDiab are good and reliable national registries.
      • Women who develop diabetes after gestational diabetes in pregnancy have higher BMI.
      • Follow up of women with gestational diabetes in pregnancy should continue after childbirth in primary care settings.

      Abstract

      Aims

      The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy.

      Methods

      This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes.

      Results

      Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p = 0.587), level of education (p = 0.549) or marital status (p = 0.849) except that the diabetes group was significantly more obese than the group without diabetes (p = 0.002).

      Conclusions

      Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.

      Abbreviations:

      GD (gestational diabetes)

      Keywords

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      References

        • Erjavec K.
        • Poljičanin T.
        • Matijević R.
        Impact of the implementation of new WHO diagnostic criteria for gestational diabetes mellitus on prevalence and perinatal outcomes: a population-based study.
        J. Pregnancy. 2016; 2016: 2670912https://doi.org/10.1155/2016/2670912
        • Damm P.
        • Houshmand-Oeregaard A.
        • Kelstrup L.
        • et al.
        Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark.
        Diabetologia. 2016; 59: 1396-1399https://doi.org/10.1007/s00125-016-3985-5
        • Hod M.
        • Kapur A.
        • Sacks D.A.
        • et al.
        The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care.
        Int. J. Gynaecol. Obstet. 2015; 131: S173-S211
        • Hashimoto K.
        • Koga M.
        Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus.
        World J. Diabetes. 2015; 6: 1045-1056https://doi.org/10.4239/wjd.v6.i8.1045
        • Aziz K.M.A.
        The art and science of managing diabetic pregnancy by insulin injections and insulin pump: evidence based reports from research trials and meta-analysis.
        Gen. Med. (Los Angeles). 2017; 5e113https://doi.org/10.4172/2327-5146.1000e113
        • Hakanen T.
        • Saha M.T.
        • Salo M.K.
        • et al.
        Mothers with gestational diabetes are more likely to give birth to children who experience early weight problems.
        Acta Paediatr. 2016; 105: 1166-1172https://doi.org/10.1111/apa.13468
        • Clausen T.D.
        • Mathiesen E.R.
        • Hansen T.
        • et al.
        High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia.
        Diabetes Care. 2008; 31: 340-346
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • et al.
        Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779https://doi.org/10.1016/S0140-6736(09)60731-5
        • Herath H.
        • Herath R.
        • Wickremasinghe R.
        Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women—a community based retrospective cohort study.
        PLoS One. 2017; 12e0179647https://doi.org/10.1371/journal.pone.0179647
        • Hopmans T.E.
        • Van Houten C.
        • Kasius A.
        • et al.
        [Increased risk of type II diabetes mellitus and cardiovascular disease after gestational diabetes mellitus: a systematic review].
        Ned. Tijdschr. Geneeskd. 2015; 159A8043
        • Kim C.
        • Newton K.M.
        • Knopp R.H.
        Gestational diabetes and the incidence of type 2 diabetes: a systematic review.
        Diabetes Care. 2002; 25 (Review): 1862-1868
        • Albareda M.
        • Caballero A.
        • Badell G.
        • et al.
        Diabetes and abnormal glucose tolerance in women with previous gestational diabetes.
        Diabetes Care. 2003; 26: 1199-1205
        • Feig D.S.
        • Zinman B.
        • Wang X.
        • Hux J.E.
        Risk of development of diabetes mellitus after diagnosis of gestational diabetes.
        CMAJ. 2008; 179: 229-234https://doi.org/10.1503/cmaj.080012
        • Rayanagoudar G.
        • Hashi A.A.
        • Zamora J.
        • et al.
        Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women.
        Diabetologia. 2016; 59: 1403-1411https://doi.org/10.1007/s00125-016-3927-2
        • Bian X.
        • Gao P.
        • Xiong X.
        • et al.
        Risk factors for development of diabetes mellitus in women with a history of gestational diabetes mellitus.
        Chin. Med. J. (Engl.). 2000; 113: 759-762
      1. Crodiab net. Available at: http://www.idb.hr/web_english/crodiabnet.htm. (Accessed 23 January 2018).

        • Poljičanin T.
        • Šekerija M.
        • Metelko Z.
        CroDiab WEB and improvement of diabetes care at the primary health care level [CroDiab WEB i unapređenje dijabetološke skrbi u primarnoj zdravstvenoj zaštiti].
        Acta Med. Croatica. 2010; 64: 349-354
      2. Croatian Society for Gynaecology and Obstetrics. Available at: http://www.hdgo.hr/Pages/Print.aspx?sifraStranica=171&kultura=hr. (18 January 2018).

        • Djelmis J.
        • Ivanisević M.
        • Juras J.
        • Herman M.
        Dijagnoza hiperglikemije u trudnoci.
        Gynecologia at perinatologia. 2010; 19: 86-89
        • International Association of Diabetes and Pregnancy Study Group
        International Association of Diabetes and Pregnancy Study Group recommendations on the diagnosis and classification of hyperglycemia in pregnancy.
        Diabetes Care. 2010; 33: 676-682
        • Persson B.
        • Hanson U.
        • Hartling S.G.
        • Binder C.
        Follow-up of women with previous GDM. Insulin, C-peptide, and proinsulin responses to oral glucose load.
        Diabetes. 1991; 40: 136-141
        • Erjavec K.
        • Poljičanin T.
        • Rodin U.
        • Matijević R.
        Prevalence of gestational diabetes in Croatia.
        Croat. J. Public Health. 2016; 12: 10-14
        • Ratner R.E.
        • Christophi C.A.
        • Metzger B.E.
        • et al.
        Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions.
        J. Clin. Endocrinol. Metab. 2008; 93: 4774-4779https://doi.org/10.1210/jc.2008-0772
        • Pedersen A.L.W.
        • Terkildsen Maindal H.
        • Juul L.
        How to prevent type 2 diabetes in women with previous gestational diabetes? A systematic review of behavioural interventions.
        Prim. Care Diabetes. 2017; 11: 403-413https://doi.org/10.1016/j.pcd.2017.05.002
        • Claesson R.
        • Ignell C.
        • Shaat N.
        • et al.
        HbA1c as a predictor of diabetes after gestational diabetes mellitus.
        Prim. Care Diabetes. 2017; 11: 46-51https://doi.org/10.1016/j.pcd.2016.09.002
        • American Diabetes Association
        Standards of medical care in diabetes—2013.
        Diabetes Care. 2013; 36: S11-S66
      3. Diabetes in pregnancy: management from preconception the postnatal period, Guidance and guidelines, NICE. (2015). Retrieved from: https://www.nice.org.uk/guidance/ng3/chapter/1-Recommendations#intrapartum-care-2. (Accessed 23 January 2018).

        • Butalia L.
        • et al.
        Postpartum diabetes testing rates after gestational diabetes mellitus in Canadian women: a population-based study.
        Can. J. Diabetes. 2017; 41: 613-620https://doi.org/10.1016/j.jcjd.2016.12.013
        • Tovar A.
        • Chasan-Taber L.
        • Eggleston E.
        • et al.
        Postpartum screening for diabetes among women with a history of gestational diabetes mellitus.
        Prev. Chron. Dis. 2011; 8A124
        • Van Ryswyk E.M.
        • Middleton P.F.
        • Hague W.M.
        • Crowther C.A.
        Women’s views on postpartum testing for type 2 diabetes after gestational diabetes: six month follow-up to the DIAMIND randomised controlled trial.
        Prim. Care Diabetes. 2017; 10: 91-102https://doi.org/10.1016/j.pcd.2015.07.003
        • Shah B.R.
        • Lipscombe L.
        • Feig D.S.
        • Lowe J.M.
        Missed opportunities for type 2 diabetes testing following gestational diabetes: a population-based cohort study.
        BJOG. 2011; 118: 1484-1490https://doi.org/10.1111/j.1471-0528.2011.03083
        • Carson M.P.
        • Frank M.I.
        • Keely E.
        Original research: postpartum testing rates among women with a history of gestational diabetes—systematic review.
        Prim. Care Diabetes. 2017; 7: 177-186https://doi.org/10.1016/j.pcd.2013.04.007