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Abstract Background Although the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria. Methods This retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes. Results Among 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6–292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72). Conclusions A modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.

Abstract Background Although breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes. Methods In this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum. Results Among 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n = 70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n = 18) (46% vs. 78%, p = 0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41 ± 1.02 vs. 2.28 ± 1.05, p = 0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding. Conclusions In Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.

Objective: Gestational diabetes (GDM) is considered as mild maternal hyperglycemia during late pregnancy. However, the significance of mild hyperglycemia during early pregnancy (before 20 weeks' gestation) is still controversial. We investigated to identify the characteristics and significance of Japanese women with GDM who were diagnosed before 20 weeks' gestation. Methods: This retrospective study included Japanese women who were diagnosed with GDM before 20 weeks' gestation (the early GDM [e-GDM] group) and those who were diagnosed at 24 weeks' gestation or later (the late GDM [l-GDM] group). We used IADPSG criteria to diagnose GDM. We compared the maternal characteristics and perinatal outcomes between the groups. Results: We included 117 and 351 women in the e- and l-GDM groups, and the mean gestational age (GA) at diagnosis was 13.7±4.3 and 28.0±3.1 weeks, respectively. Maternal prepregnancy body mass index (BMI) in the e-GDM group was significantly higher than that in the l-GDM group (24.7±4.9 vs. 23.0±4.6, p=0.002). Although fasting plasma glucose (PG) levels were also significantly higher in the e-GDM group (88.7±8.9 vs. 84.3±10.8 mg/dl, p<0.0001), there were no significant differences in the 1- and 2-hour PG values between the groups. The mean GA at the beginning of insulin therapy was 21.1±7.3 and 30.0±4.6 weeks in the e- and l-GDM groups, respectively. The rate of insulin therapy was higher in the l-GDM group (41.9% vs. 52.3%, p<0.05). The perinatal outcomes did not differ between the groups. When we compared in the obese subgroups (prepregnancy BMI ≥2 ), we found the prepregnancy BMI was significantly higher in the e-GDM group (31.6±4.7 vs. 29.3±3.4, p=0.0016). However, there were no significant differences in the rate of insulin administration (52.4% vs. 65.6%, ns) or in the perinatal outcomes between the groups. Conclusion: The Japanese women with GDM who were diagnosed before 20 weeks were more frequently obese than those who were diagnosed at 24 weeks or later. The findings suggest that early diagnosis and treatment intervention seemed to be beneficial in obese women with GDM. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes (GDM) is one of the most common complications during pregnancy, up to 12% or more of all pregnant women. It is well established evidence that women affected by GDM during pregnancy are high risk of the development of diabetes after delivery. Several studies showed that breastfeeding has a protective effect against the development of diabetes in general population and in women with GDM during pregnancy. However, underlying mechanism regarding the protective effect has not been clearly understood. Therefore, in this study, we investigated the effect of breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes. Methods: In this retrospective study, we included women who were diagnosed as having GDM after 24 weeks' gestation during pregnancy and underwent postpartum 75g oral glucose tolerance test (OGTT) during the first year postpartum at a single tertiary perinatal care center in Japan. We used IADPSG criteria and WHO criteria to make a diagnosis of GDM during pregnancy and abnormal glucose tolerance (AGT) after delivery, respectively. We defined AGT as impaired glucose intolerance and diabetes by WHO criteria. Regarding breastfeeding conditions, we defined highintensity breastfeeding (HIB) as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume, and other statuses, including partial and non-breastfeeding, as non-HIB. We investigated the effect of HIB on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum. Results: We included 88 women affected by GDM during pregnancy, and among them, 46 (52%) women had AGT during the postpartum period. Among the all participants, 70 (79.5%) women fed their infants by HIB at least 6 weeks or more during postpartum period (HIB group), and the other 18 (20.5%) women were in the non-HIB group. HIB women were significantly less likely to have AGT than non-HIB women (46% vs. 78%, p<0.02). Women in the HIB group were also associated with a lower HOMA-IR at one year postpartum than those in the non-HIB group (1.41±1.02 vs. 2.28±1.05, p=0.035). Regarding the duration of breastfeeding, we found that at least six months of HIB had a significant effect of both reducing the prevalence of the AGT and improving HOMA-IR during one year postpartum, in comparison with non-HIB. Conclusions: In Japanese women with GDM, HIB at least 6 months or more had a protective effect against the development of AGT during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change. [ABSTRACT FROM AUTHOR]