Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial

N Wah Cheung; Yoon J J Rhou; Jincy Immanuel; William M Hague; Helena Teede; Christopher J Nolan; Michael J Peek; Jeff R Flack; Mark McLean; Vincent W Wong; Emily J Hibbert; Alexandra Kautzky-Willer; Jürgen Harreiter; Helena Backman; Emily Gianatti; Arianne Sweeting; Vishwanathan Mohan; David Simmons

doi:10.1016/j.diabres.2024.111929

Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial

Diabetes Res Clin Pract. 2024 Dec:218:111929. doi: 10.1016/j.diabres.2024.111929. Epub 2024 Nov 12.

Authors

N Wah Cheung¹, Yoon J J Rhou², Jincy Immanuel³, William M Hague⁴, Helena Teede⁵, Christopher J Nolan⁶, Michael J Peek⁷, Jeff R Flack⁸, Mark McLean⁹, Vincent W Wong¹⁰, Emily J Hibbert¹¹, Alexandra Kautzky-Willer¹², Jürgen Harreiter¹³, Helena Backman¹⁴, Emily Gianatti¹⁵, Arianne Sweeting¹⁶, Vishwanathan Mohan¹⁷, David Simmons¹⁸

Affiliations

¹ Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Sydney, NSW Australia. Electronic address: wah.cheung@sydney.edu.au.
² Westmead Hospital, Westmead, NSW, Australia; University of Sydney, Sydney, NSW Australia. Electronic address: yoonji.rhou@health.nsw.gov.au.
³ Western Sydney University, Campbelltown, NSW, Australia. Electronic address: j.varghese@westernsydney.edu.au.
⁴ Robinson Research Institute, The University of Adelaide, SA, Australia. Electronic address: bill.hague@adelaide.edu.au.
⁵ Monash University, Melbourne, Vic, Australia. Electronic address: helena.teede@monash.edu.au.
⁶ Canberra Health Services, Canberra, Australia; Australian National University, Canberra, Australia. Electronic address: christopher.nolan@anu.edu.au.
⁷ University of Sydney, Sydney, NSW Australia; Nepean Hospital, Sydney, NSW, Australia. Electronic address: michael.peek@sydney.edu.au.
⁸ Bankstown-Lidcombe Hospital, Sydney, Australia. Electronic address: jeff.flack@health.nsw.gov.au.
⁹ Blacktown Hospital, Sydney, Australia. Electronic address: mark.mclean@health.nsw.gov.au.
¹⁰ Liverpool Hospital, Sydney and University of New South Wales, NSW, Australia. Electronic address: vincent.wong1@health.nsw.gov.au.
¹¹ University of Sydney, Sydney, NSW Australia; Nepean Hospital, Sydney, NSW, Australia. Electronic address: emily.hibbert@sydney.edu.au.
¹² Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria. Electronic address: alexandra.kautzky-willer@meduniwien.ac.at.
¹³ Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Medicine, Landesklinikum Scheibbs, Austria. Electronic address: juergen.harreiter@meduniwien.ac.at.
¹⁴ Dept of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Sweden. Electronic address: helena.backman@regionorebrolan.se.
¹⁵ Department of Endocrinology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia. Electronic address: emily.gianatti@health.wa.gov.au.
¹⁶ Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: arianne.sweeting@sydney.edu.au.
¹⁷ Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India. Electronic address: drmohans@diabetes.ind.in.
¹⁸ Western Sydney University, Campbelltown, NSW, Australia. Electronic address: da.simmons@westernsydney.edu.au.

PMID: 39536979
DOI: 10.1016/j.diabres.2024.111929

Abstract

Aim: To evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks' gestation.

Methods: This is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for gestational diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6-12 weeks postpartum.

Results: Of 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia.

Conclusion: There is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.

Keywords: Dysglycaemia; Gestational diabetes; Glucose tolerance test; Post-partum.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Blood Glucose* / analysis
Blood Glucose* / metabolism
Diabetes, Gestational* / blood
Diabetes, Gestational* / diagnosis
Diabetes, Gestational* / epidemiology
Female
Follow-Up Studies
Glucose Intolerance* / blood
Glucose Intolerance* / diagnosis
Glucose Intolerance* / epidemiology
Glucose Tolerance Test*
Humans
Incidence
Postpartum Period*
Pregnancy
Risk Factors

Substances

Blood Glucose