Antenatal glycemic control in gestational diabetes and its association with postpartum glucose intolerance and weight...

Evidence linking antenatal glycemic control to postpartum dysglycemia and weight retention in real‑world GDM care is limited. The authors tested whether late‑pregnancy control predicts early postpartum glucose intolerance and 12‑month Postpartum Weight Retention (PPWR).

In this single‑center prospective cohort, women with GDM were enrolled from May 2021 to April 2024. Antenatal control (28-36 weeks) from routine SMBG was summarized as Time‑In‑Target (TIT). Mean fasting/postprandial glucose were recorded. The primary outcome was postpartum glucose intolerance by 75 g OGTT at 6-12 weeks, and secondary outcomes were PPWR and substantial PPWR (≥ 5 kg) at 12-months. Multivariable logistic and mixed‑effects models adjusted for prespecified confounders.

Of 348 enrollees, 287 (82.5%) completed the postpartum OGTT and 267 (76.7%) had 12‑month weight. Postpartum glucose intolerance occurred in 82/287 (28.6%). Each 10% lower TIT was associated with higher odds of dysglycemia (adjusted OR [aOR = 1.24], 95% CI 1.10-1.39). The poorest‑ vs. best‑control quartiles had aOR = 2.15 (95% CI 1.31-3.53). Mean PPWR at 12-months was 3.4 ± 4.1 kg; each 10% lower TIT corresponded to +0.32 kg PPWR (95% CI 0.12-0.52) and increased odds of substantial PPWR ≥ 5 kg (aOR = 1.13, 95% CI 1.02-1.25), with Q4 vs. Q1 aOR = 1.92 (95% CI 1.11-3.33).

Poorer antenatal control was independently associated with postpartum dysglycemia and greater 12‑month weight retention, supporting risk‑stratified postpartum OGTT follow‑up and early lifestyle support.