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Prior gestational diabetes may lead to hidden metabolic disturbances (Healio Endocrine Today)

Women with normal glucose tolerance 5 years after a gestational diabetes diagnosis may still have hidden metabolic disturbances, according to research published in International Journal of Endocrinology.

Women with prior gestational diabetes — despite current normal glucose tolerance — had more hyperglycemia and insulin resistance,  decreased adiponectin and increased C-reactive protein concentrations compared with a healthy control group, thereby linking metabolic disturbances to an increased cardiovascular risk, according to the researchers.

“We could assume that [women with prior gestational diabetes], despite normal glucose tolerance, have an increased cardiovascular risk and should be considered as high-risk populations for cardiovascular disease,” the researchers wrote.

Yvonne Winhofer, MD, of Medical University of Vienna, and colleagues at other institutions compared data from 45 women with prior gestational diabetes and a normal glucose tolerance at their 5-year follow-up with 18 women without a history of gestational diabetes. The women were matched for age (37 ± 4.1 years vs. 35.2 ± 5.3 years, respectively) and BMI (24.3 ± 3.1 kg/m2 vs. 23.3 ± 3.3 kg/m2, respectively). Researchers conducted oral and IV glucose tests and assessed lipid profiles, and levels of C-reactive protein, adiponectin, leptin and glucagon. Data from the visit 5 years postpartum were compared between the groups with the baseline examination 6 months after delivery.

Five years postpartum, the women with prior gestational diabetes had increased glucose concentrations during the oral glucose tolerance test (P = .003) and decreased insulin sensitivity compared with the control group (P = .01). Women with prior gestational diabetes also had lower adiponectin (P < .008) but increased waist circumference despite a BMI comparable to the control group. In addition, women in the diabetes group who had experienced weight loss of at least 7% within the 5-year follow-up period exhibited pronounced metabolic disturbances when compared with healthy controls.

The study was part of the Viennese Post-Gestational Diabetes Project, a prospective longitudinal study in women with a history of gestational diabetes.

More studies are needed to better understand the development of overt hyperglycemia and develop treatment strategies, which can improve prevention, according to the researchers.

“Metabolic disturbances which predispose [women with prior gestational diabetes] to the development of overt diabetes appear to be chronic and can be hidden but, still, remain life-long, and therefore regular follow-ups should be recommended to all women with a history of [gestational diabetes] in order to detect diabetes in time and prevent complications, especially the onset of cardiovascular disease,” the researchers wrote. – by Regina Schaffer