Related Factors For Abnormal Postpartum Glycemic States In Women Diagnosed With Gestational Diabetes During Early Postpartum

Objective: To investigate the abnormal glucose metabolism of Gestational Diabetes Mellitus(GDM)patients at 6-8 weeks postpartum,and to analyze the relationship between demographic indicators,clinical data during pregnancy and behavioral conditions related to postpartum glucose management,diet,exercise and neonatal feeding and abnormal glucose metabolism.Methods: Taking the obstetric ward of a 3a hospital in Hunan Province as the research site,and a nested case-control study method was used to complete a baseline survey at the time of admission of the subjects to the hospital for delivery and to follow them up at 6 to 8 weeks after delivery.The case group with abnormal glucose metabolism and the control group with normal glucose metabolism were identified according to their glucose screening by oral glucose tolerance test(OGTT)at 6 to 8 weeks postpartum.A questionnaire was used to collect general demographic indicators,prepregnancy clinical characteristics,pregnancy characteristics,and postpartum characteristics related to exercise,feeding,and diet.Univariate analyses were performed using chi-squared,analysis of variance,and Wilcoxon rank-sum tests as appropriate to evaluate the association between an abnormal postpartum OGTT and each study factor.Association of multiple factors with abnormal glucose metabolism in the early postpartum period using binary logistic regression analysis.Results:(1)A total of 220 subjects were included in the study,and 181 cases were followed up from 6-8 weeks postpartum.105 patients(58.0%)underwent postpartum blood glucose screening,73 cases(69.5%)of them had normal glucose metabolism,32 cases(30.5%)had abnormal glucose metabolism,13 cases(12.4%)had impaired glucose tolerance,9 cases(5.0%)had impaired fasting glucose,8 cases(7.6%)had impaired glucose tolerance combined with impaired fasting glucose,and diabetes mellitus was 2 cases(1.9%).(2)Univariate analysis showed that age,pre-pregnancy overweight or obesity,menstruation,history of gestational diabetes,family history of diabetes,mid-pregnancy fasting glucose,OGTT 1-hour glucose value,OGTT 2-hour glucose value,prenatal BMI,area under the OGTT timeglucose curve ≥ 16.8 mmol/(L·h),postpartum management of blood glucose through dietary control,the mean daily sedentary behavior time,and heavy dietary tastes were statistically different between the case and control groups.(3)Multivariate logistic regression analysis showed that: Age at delivery > 31 years(OR=3.233,95%CI: 1.121-9.322),overweight or obesity before pregnancy(OR=7.204,95%CI: 2.266-22.901),history of GDM(OR=5.769,95%CI: 1.128-29.495),high blood glucose within 1hour of OGTT(OR=2.184,95%CI: 1.102-4.328)and preferring stronger flavor after delivery(OR=6.756,95%CI: 1.071-42.608)were risk factors for abnormal glucose metabolism in early postpartum GDM patients.Conclusion:(1)The rate of glucose metabolism abnormalities at 6 to 8 weeks postpartum in gestational diabetic patients was high at 30.5% in the obstetrics department of a 3a hospital in Hunan Province investigated in this study.(2)Older than 31 years at delivery,pre-pregnancy overweight or obesity,history of GDM,higher blood glucose at 1-hour OGTT in the second trimester,and strong diet taste after delivery were important risk factors for abnormal glucose metabolism at 6-8 weeks postpartum in GDM patients.