Prognosis And Related Factors Of Postnatal Glucose Metabolism In Patients With Gestational Diabetes At 6-12 Weeks Postpartum

Objective:To reevaluate the glucose metabolism in patients with gestational diabetes during 6-12 weeks postpartum,and to analyze the relationship between pre-pregnancy and hospitalization indicators and the outcomes of glucose metabolism at 6-12 weeks postpartum.Methods:Patients with GDM admitted to our hospital from April 2014 to October 2018were collected.The patients were followed up for 6-12 weeks postpartum OGTT.According to the World Health Organization,the glucose metabolism status of 6-12weeks of postpartum was divided into the normal glucose metabolism group and the abnormal glucose metabolism group.Compare the following risk factors of the two groups:pre-pregnancy indicators(body mass index before pregnancy,family history of diabetes,birth history,abortion history),pregnancy indicators(gestational weeks at diagnosis of GDM,gestational age,OGTT fasting plasma glucose and OGTT2-hour blood glucose,glycosylated hemoglobin,fasting c-peptide,1-hour c-peptide,2-hour c-peptide,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,uric acid,insulin dose required at discharge,gestational age at birth)and neonatal weight,and carry out correlation analysis.Results:1.Of the 189 patients with GDM,125 were followed up and the follow-up rate was 66.1%.5 cases of them had unexplained abortions.Among the 120 GDM patients,72(60.0%)had normal glucose metabolism and 48(40.0%)had abnormal glucose metabolism,of which 13 cases(10.8%)with impaired fasting glucose,12cases(10.0%)with abnormal glucose tolerance,10 cases(8.3%)with impaired fasting glucose combined with abnormal glucose tolerance,and 13 cases(10.8%)with diabetes;2.GDM patients who were overweight(24 kg/m~2≤BMI<28 kg/m~2)and obese(BMI≥28 kg/m~2)before pregnancy had a significantly higher proportion of postpartum persistent abnormal glucose metabolism than those with normal BMI before pregnancy,P<0.001;3.The older patients with GDM had a significantly higher proportion of postpartum persistent abnormal glucose metabolism,P<0.001;4.The proportion of postpartum persistent abnormal glucose metabolism in GDM patients with a family history of diabetes was significantly higher than those without a family history of diabetes,P<0.001;5.OGTT fasting plasma glucose and OGTT 2-hour blood glucose were significantly higher in the abnormal glucose metabolism group than in the normal glucose metabolism group,P=0.0007,P=0.0018;6.In terms of gestational weeks at diagnosis of GDM,birth history,abortion history,glycosylated hemoglobin,fasting c-peptide,1-hour c-peptide,2-hour c-peptide,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,uric acid,insulin dose required at discharge,gestational age at birth and neonatal weight,no statistical differences were found between the two groups(P>0.05);7.Statistically significant univariate variables were adjusted by multivariate influencing factors.GDM patients had a family history of diabetes,the higher pre-pregnancy BMI,the older age,and the risk of postpartum continuous abnormal glucose metabolism was higher;Conclusions:1.Pre-pregnancy BMI,gestational age,family history of diabetes,OGTT fasting plasma glucose and OGTT 2-hour blood glucose at diagnosis were risk factors for abnormal glucose metabolism in GDM patients at 6-12 weeks postpartum;2.Pre-pregnancy BMI,gestational age and family history of diabetes were independent risk factors for abnormal glucose metabolism in GDM patients at 6-12weeks postpartum;3.GDM patients are recognized as high-risk groups of DM.Paying attention to the blood glucose management during pregnancy,the re-evaluation of postpartum glucose metabolism and persistent concerns to blood glucose are effective methods to reduce or delay the occurrence of DM;...