Progression to Abnormal Glucose Tolerance and Its Related Risk Factors Among Women with Prior Gestational Diabetes in Rural Communities of China

Ping Mao,1 Shan Jiang,2 Jia Guo,2 Yuanyuan Jiang,2 Qing Long,2 Yujia Tang,2 Jiaxin Luo,2 James Wiley,3 Allison Vorderstrasse4 1Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China; 3School of Medicine, University of California, San Francisco, San Francisco, CA, USA; 4School of Nursing, New York University, New York, NY, USACorrespondence: Jia GuoXiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, Hunan 410013, People’s Republic of ChinaTel +86 13875947418Email guojia621@163.comBackground: The purpose of this study was to describe the status of abnormal glucose tolerance with a longer duration after delivery among women with prior gestational diabetes mellitus (GDM) in a rural community of China, and to explore the influence of socio-demographic factors, GDM-related factors (family history of diabetes, number of children, receipt of treatment for GDM), psychosocial factors (perceived stress, self-efficacy, and social support), lifestyle behaviors (physical activity, sedentary activity, fruit or vegetables intake), and obesity indicators (body mass index and waist circumferences) on abnormal glucose tolerance.Patients and Methods: A cross-sectional descriptive survey was conducted among women with prior GDM in two county-level hospitals in Western and Eastern Hunan, China from November 2017 to June 2018. Under the guidance of life course theory, data were collected using self-report measures of socio-demographic and GDM-related factors as well as psychosocial factors (perceived stress, self-efficacy, and social support) and postpartum lifestyle behaviors (physical activity, sedentary activity, and fruit and vegetable intake). Additionally, a 75-g oral glucose tolerance test was conducted, and weight, height, and waist circumference were measured on site.Results: A total of 425 women were included in this study, with an average postpartum duration of 18.04 months. Of these women, 20.9% had abnormal glucose tolerance (AGT). A multivariate analysis indicated that the proportion of abnormal glucose tolerance increased with increased age (OR = 2.13; 1.27– 3.57, p=0.004), ethnic minority (OR: 1.62, 95% CI: 0.96– 2.72, p=0.069), lower educational levels (OR:0.58, 95% CI: 0.33– 1.02, p=0.057), receipt of treatment for GDM during pregnancy (OR =1.93; 1.11– 3.37, p=0.020) and larger waist circumference (OR = 1.08; 1.05– 1.12, p=0.000).Conclusion: More than one-fifth of the women with GDM in rural China had progression to AGT. More postpartum programs aimed at reducing waist circumference are warranted to delay or prevent progression to type 2 diabetes mellitus for rural Chinese women with prior GDM.Keywords: gestational diabetes mellitus, abnormal glucose tolerance, postpartum, risk factors, waist circumference