Clinical and metabolic characterization of women with gestational diabetes mellitus within the first year post-partum

Abstract Context Women with gestational diabetes mellitus (GDM) have an increased risk of long-term complications, including impaired glucose metabolism, type 2 diabetes (T2DM), cardiovascular disease, and obesity. In current clinical practice, a one-size-fits-all approach to GDM is applied, although heterogeneity among women with GDM has been recognized. Objective To give the most adequate preventive care and post-partum (PP) guidance, we aimed to make a metabolic characterization and identify subgroups of women with previous GDM within the first year PP. Methods In this prospective cohort study, we collected data in gestational week 34-38, at 3 months, and 1 year PP on women with GDM, who participated in a PP follow-up program in Central Region Denmark from April 2019- December 2022. Results In total 1270 women were included in the program in late pregnancy. Of the 768 women participating in either oral glucose tolerance test (OGTT) 3 months PP (n = 545) or 1-year follow-up (n = 493) or both (n = 261), 608 (79.2%) were normoglycemic, 137 (17.8%) had prediabetes, 20 (2.6%) had T2DM, and 3 (0.4%) had developed T1DM. More than 40% of the women gained weight in the first year PP, compared to their pregestational weight. Conclusion Our study shows that 20.8% of women with GDM who volunteered to participate in a clinical follow up programme developed prediabetes or diabetes (T1DM and T2DM) within the first year PP. The GDM diagnosis encompasses a heterogenetic group of women and a deeper characterization may provide an opportunity for a more personalized risk assessment to prevent the progression to T2DM.