Gestational Diabetes Mellitus: an Opportunity to Prevent Type 2 Diabetes and Cardiovascular Disease in Young Women

Graziano Di Cianni; Alessandra Ghio; Veronica Resi; Laura Volpe

Disclosures

Women's Health. 2010;6(1):97-105. 

In This Article

Prevention of T2DM & CVD

The American Diabetes Association recommends that women with GDM should be reclassified at 6 weeks after the index pregnancy in order to detect persistent glucose abnormalities.[45] For those who maintain impaired fasting glucose or glucose intolerance after the pregnancy, annual OGTTs should be performed. Furthermore, women with pGDM who give normotolerant results at the first evaluation after delivery should have an OGTT with regular intervals, beginning 1 year after pregnancy. Markers of MS, such as abdominal circumferences, blood pressure and lipid profile may be investigated in addition to the OGTT (Figure 3).

Although follow-up recommendations for women with pGDM are well defined, there are numerous citations in the literature documenting a lack of follow-up care during the postpartum period for GDM.[46–48] A lack of primary care survillance in a relatively young, mobile population that underestimates their risk of T2DM, and the difficulties associated with adherence to diet and exercise in women who are busy providing care for young children, do not easily allow for a high rate of postpartum follow-up that remain only approximately 50% in this population.[49]

It is now well documented in different populations, including Americans,[50] Finnish[51] and Asians[52] with prediabetes, that lifestyle changes with increased physical activity, weight loss and a healthy diet can reduce the risk of progressing to T2DM. In addition, pharmacological intervention (e.g., with metformin[50]) has been found to reduce progression to T2DM. Although a common characteristic of these studies is that the subjects were seen intensively over a long period of time, it seems rational to consider similar interventions in women with pGDM. Women with self-reported pGDM, who form a subset of the population who enrolled in the Diabetes Prevention Program, experienced a 55% reduction in the development of T2DM with the lifestyle intervention when compared with those in the placebo group.[53] Considering that this study was limited by the self-reporting of pGDM and the fact that diagnosis of GDM was not validated, these results should not be considered conclusive. Other studies on this topic are not available. Therefore, in order to determine the potential benefit of lifestyle modification and in order to evaluate the most effective way to achieve it, postpartum studies of healthy diet and exercise plans should be performed in women with pGDM.

Several randomized clinical trials have specifically studied diabetes prevention with pharmacological intervention in women with pGDM. Buchanan et al., in the Troglitazone in the Prevention of Diabetes (TRIPOD) study,[54] found a 55% risk reduction in progression to T2DM in women who received troglitazone when compared with those who received placebo. They reported an improvement of insulin sensitivity that persisted for 8 months after study medication stopped. The Pioglitazone in Prevention of Diabetes (PIPOD) study[55] enrolled women who had completed the previous study without developing T2DM. A 4.6% yearly incidence rate of T2DM was reported in the pioglitazone group, which was significantly lower than that reported in placebo group (12%). Women with pGDM enrolled in the Diabetes Prevention Program and treated with metformin had a 50% reduction of diabetes risk. However, in the same study, treatment with metformin was associated with a 14% T2DM risk reduction in women without pGDM.[56]

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