Abstract

Objective: This study aimed to identify the prevalence of postpartum glucose intolerance and to develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.

Methods: A prospective cohort study was conducted on women with gestational diabetes mellitus (GDM) diagnosed using the updated international diagnostic criteria. All women who had GDM were advised to undergo postpartum oral glucose tolerance test (ppOGTT) at 6-12 weeks of delivery. Predictors of postpartum glucose intolerance were identified using the multivariate analysis. The discriminative power of the predictable variables for postpartum glucose intolerance and the model accuracy were computed by the area under the receiver operating characteristic (ROC) curve and estimated by the area under the curve (AUC) with 95% confidence interval.

Results: Of all women with GDM, 112 (85.5%) attended and completed the ppOGTT. The prevalence of postpartum glucose intolerance was 21.4% (95% CI: 14.3–28.4) inclusive of 18.7% prediabetes and 2.7 % diabetes. Multivariate logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose (FPG) level at diagnosis, overweight and/or obesity, and antenatal depression were predictors for postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI: 0.822 to 0.937). The FPG at GDM diagnosis [AUC= 0.736 (95% CI: 0.616-0.845)] and overweight and/or obesity [AUC = 0.718 (95% CI:0.614- 0.814)] were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of FPG at diagnosis and mid-upper arm circumference (MUAC) was 0.822 (95% CI:0.722- 0.907), which was the best predictor.

Conclusions: Our finding confirmed prevalence of postpartum glucose intolerance is high among women with GDM. Antenatal predictors were modestly predicted postpartum glucose intolerance. The findings suggested the ongoing glucose screening is indicated for all women with GDM.

Keywords: gestational diabetes mellitus, post-partum glucose intolerance, prediction