Weight retention and glucose intolerance in early postpartum after gestational diabetes

To determine risk factors for early postpartum weight retention (PPWR) and glucose intolerance (GI) in women with gestational diabetes (GDM).

Prospective, multicenter (n=8) cohort study in 1201 women with a recent history of GDM. Pregnancy and postpartum characteristics, and data from self-administered questionnaires were collected at the 6-16 weeks postpartum 75g OGTT.

Of all participants, 38.6% (463) had moderate (>0 and ≤5 kg) and 15.6% (187) had high (>5kg) PPWR. Independent predictors for early PPWR were excessive gestational weight gain (GWG), lack of breastfeeding, higher dietary fat intake, insulin use during pregnancy, multiparity, lower prepregnancy BMI, and lower education degree. Compared to PPWR <5 kg, women with high PPWR had a more impaired postpartum metabolic profile, breastfed less often, had higher depression rates [23.1% (43) vs. 16.0% (74), p=0.035] and anxiety levels, and lower quality of life. Of all participants, 28.0% (336) had GI [26.1% (313) prediabetes and 1.9% (23) diabetes]. Women with high PPWR had more often GI compared to women without PPWR [33.7% (63) vs. 24.9% (137), p=0.020]. Only 12.9% (24) of women with high PPWR perceived themselves at high risk for diabetes but they were more often willing to change their lifestyle than women with moderate PPWR.

Modifiable risk factors such as lifestyle, prepregnancy BMI, GWG, and mental health can be used to identify a subgroup of women with GDM at the highest risk of developing early PPWR, allowing for a more personalized follow-up.