A study of post-partum persistence of glucose intolerance and its association with metabolic risk factors in gestational diabetes mellitus patients in urban South-Indian population

Background: Gestational diabetes mellitus, as a metabolic disorder affects 1%-28% of pregnancies. History of gestational diabetes is an important predictor of various metabolic disturbances later in life. This study was intended to observe the impact of the various predictors over persistence of abnormal glucose tolerance at post-partum and its association with metabolic risk factors. Materials and methods: This was a prospective study of 216 GDM women diagnosed by 75 g oral glucose tolerance test (OGTT) during index pregnancy attending diabetology OPD in Institute of social obstetrics and Kasturba Gandhi general hospital between January 2016 to March 2018. At 6-12 weeks post-partum, 75 g - 2 hr-OGTT was done to assess their glycemic status. Data for predictors and metabolic risk factors were obtained from history, clinical examination and personal records. Plasma glucose was measured by glucose-oxidase method. The results were calculated using SPSS software and expressed in percentage. Results: Of the 216 women only 173 patients came for postpartum follow up at 6- 12 weeks. Normal glucose tolerance (NGT) was seen in 58.9% and abnormal glucose tolerance (AGT) in 41.1%. The frequency of abnormal glucose intolerance includes IFG: 0.9%, IGT: 24.5%, DM: 15.7%. Gestational age <20 week at detection of GDM, higher parity, insulin use during pregnancy, previous history of GDM, higher glucose levels on the diagnostic OGTT, hypertension were significantly higher in the AGT group. However positive family history of diabetes and BMI showed no statistically significant correlation. Conclusion: It is concluded that advanced age, higher parity, previous history of GDM, earlier gestational age at diagnosis of GDM and use of insulin during pregnancy are important predictors for AGT during post-partum period and hypertension as a metabolic risk factor was strongly associated with AGT. Need for early postpartum screening and implementation of various intervention program to prevent type 2 diabetes in high risk GDM women.