Lesson 1: Navigating the Journey After Gestational Diabetes

Having gestational diabetes (GDM) can affect a woman's health for a long time. It can increase her chance of developing type 2 diabetes by up to 60% (source). It’s important to understand how healthcare providers diagnose GDM, what it means when the standards for diagnosis change, and what to do after giving birth to minimize your risk of developing type 2 diabetes in the future.

Key Takeaways:

  • Diagnostic Evolution: The way doctors diagnose gestational diabetes has changed since the 1960s, affecting the number of women that are diagnosed. The adoption of International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria will lead to more GDM cases being detected, and that means we need to rethink how we support women after giving birth.

  • Risk Factors During Pregnancy: High blood sugar levels during pregnancy are the strongest predictor of future type 2 diabetes. Family history of type 2 diabetes and other factors like age or the number of babies a woman has delivered show inconsistent associations with developing type 2 diabetes.

  • Postpartum Risks: After delivering a baby, factors like breastfeeding and body weight affect a woman’s chances of developing abnormal glucose (sugar) tolerance. Women with a history of GDM have a higher risk, but the risk of being diagnosed with type 2 diabetes varies depending on what cut-off doctors use, and how long it’s been since a woman’s pregnancy ended.

  • Relevance of IADPSG Criteria: The new IADPSG criteria bring challenges, necessitating lifelong follow-up for a larger GDM population. The criteria's impact on rates of diabetes diagnosis remains uncertain, requiring further research.

  • Overt Diabetes and Follow-Up: Women with overt (definite) diabetes are at the highest risk. Current follow-up recommendations vary, with different expert groups suggesting different approaches, including Oral Glucose Tolerance Test (OGTT), Hemoglobin A1c (HbA1c), and Fasting Plasma Glucose (FPG).

Conclusion:

Even though research studies vary, having a history of GDM history significantly increases a woman’s risk of type 2 diabetes. The adoption of the IADPSG criteria raises questions about how closely and how often women should be checked for type 2 diabetes after giving birth. Future studies are needed to improve postpartum strategies and provide personalized care for women who have experienced GDM.