Mild gestational hyperglycemia and the metabolic syndrome in later life

Diabetes and obesity, components of the metabolic syndrome, are common longterm complications in women with previous gestational diabetes (pGDM). Long-term follow-up of women with mild gestational hyperglycemia is lacking.

Fifty women with previous positive oral glucose challenge test and negative oral glucose tolerance test (pOGCT+OGTT-), 161 with previous normal glucose tolerance (pNGT), and 182 pGDM were studied after 6.5 years from the index pregnancy.

Patients with pGDM showed a worse metabolic pattern than pNGT. Women with pOGCT+OGTT- had significantly higher levels of fasting glucose, homeostasis model assessment (HOMA), percentage of impaired fasting glucose, and low age and high-density lipoprotein (HDL)-cholesterol than pNGT subjects. Prevalence of the metabolic syndrome (MS) was, respectively, sixfold and twofold higher in pGDM and pOGCT+OGTT- than in pNGT. In a Cox proportional hazard model, after multiple adjustments, pGDM was significantly associated with subsequent hyperglycemia (hazard ratio [HR] = 4.2; 95% CI 1.6-11.1), low HDL-cholesterol (HR = 1.7, 1.1-2.8), hypertriglyceridemia (HR = 4.2, 1.2-14.9), hypertension (HR = 2.2, 1.3-3.6), MS (HR = 3.7, 1.3-10.8), while pOGCT+OGTT- was associated with subsequent hyperglycemia (HR = 4.3, 1.3-14.7), and low HDL-cholesterol (HR = 2.0, 1.0-3.8). The metabolic syndrome was present in 52.6% of obese pGDM, 50% of obese pOGCT+OGTT-, and 28.6% of obese pNGT women; the corresponding HRs were, respectively, HR = 2.20, 0.74-6.57 (pGDM), and HR = 3.56, 1.10-11.5 (pOGCT+OGTT-).

Women who failed the OGCT, but not the OGTT, showed a subsequent worse metabolic pattern than pNGT subjects, independently of confounding factors. In the presence of obesity, the prevalence of the metabolic syndrome was similar to that of obese pGDM women, and almost twofold higher than in obese pNGT controls.