What type of diabetes occurs after pregnancy, specifically Gestational Diabetes (GDM)?

From the Guidelines

Women who have had Gestational Diabetes Mellitus (GDM) are at increased risk of developing type 2 diabetes later in life, with an estimated 50-60% lifetime risk 1. Key points:

• GDM usually disappears after giving birth
• Women should be tested for diabetes 6-12 weeks postpartum
• Lifestyle modifications are crucial for prevention of future diabetes
• Regular screening for type 2 diabetes is recommended To reduce the risk of developing type 2 diabetes after GDM:

1. Maintain a healthy diet rich in fruits, vegetables, and whole grains
2. Exercise regularly (aim for 150 minutes of moderate activity per week)
3. Achieve and maintain a healthy weight
4. Breastfeed, if possible, as it can help regulate blood sugar levels GDM occurs due to hormonal changes during pregnancy that affect insulin sensitivity, and both metformin and intensive lifestyle intervention can prevent or delay progression to diabetes in individuals with prediabetes and a history of GDM 1. The absolute risk of developing type 2 diabetes after GDM increases linearly through a person’s lifetime, being approximately 20% at 10 years, 30% at 20 years, 40% at 30 years, 50% at 40 years, and 60% at 50 years 1. Lifestyle intervention and metformin reduced progression to diabetes by 35% and 40%, respectively, over 10 years compared with placebo 1. It is essential to note that interpregnancy weight gain is associated with increased risk of adverse pregnancy outcomes and higher risk of GDM, while weight loss is associated with lower risk of developing GDM in the subsequent pregnancy 1. Therefore, effective weight management after GDM is crucial, and postdelivery lifestyle interventions are effective in reducing the risk of type 2 diabetes 1.

From the Research

Type of Diabetes after Pregnancy

The type of diabetes that occurs after pregnancy, specifically after Gestational Diabetes (GDM), is Type 2 Diabetes Mellitus (T2DM) 2, 3, 4, 5.

Risk of Developing Type 2 Diabetes

Women with a history of GDM face a substantially higher risk of developing T2DM compared to normoglycemic pregnant women 2, 4, 5. The risk factors associated with the progression of GDM to T2DM include:

• Pregnancy at an advanced age
• Insulin treatment during pregnancy
• Delivering an overweight baby 2
• Ethnic origin, duration of follow-up, maternal age, body-mass index, and diagnostic criteria may also modify the risk 5

Management and Prevention

Effective management strategies such as lifestyle changes, postpartum care, breastfeeding, screening tests, and gaining awareness of risk are crucial to mitigate the risk of T2DM in women with a history of GDM 2, 3. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus 3. Lifestyle modification is the primary approach, while the use of medications for diabetes prevention after GDM remains controversial 3.

Long-term Consequences

The long-term consequences of developing T2DM following GDM are significant, affecting not only the health of the mother but also posing risks to the offspring 2, 4. The risks of obesity, the metabolic syndrome, type 2 diabetes, and impaired insulin sensitivity and secretion in offspring of mothers with GDM are two- to eightfold those in offspring of mothers without GDM 4.