From the Guidelines
The diabetes type that can occur after pregnancy, but is not gestational diabetes, is typically Type 2 diabetes. Women who had gestational diabetes during pregnancy have an increased risk of developing Type 2 diabetes later in life, often within 5-10 years after giving birth, with an estimated lifetime maternal risk of 50-60% 1. This is not considered gestational diabetes, as that term specifically refers to diabetes that develops during pregnancy and usually resolves after delivery.
Key Points to Consider
- The absolute risk of developing Type 2 diabetes after gestational diabetes 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.
- To manage this condition:
- Regular blood glucose monitoring is essential
- Lifestyle modifications including a healthy diet and regular exercise are crucial
- Medications like metformin may be prescribed, starting at 500mg twice daily and potentially increasing to 1000mg twice daily
- In some cases, insulin therapy may be necessary
- It's essential for women who had gestational diabetes to have their blood sugar levels checked 6-12 weeks postpartum and then every 1-3 years thereafter, using any recommended glycemic test, such as annual A1C, annual fasting plasma glucose, or triennial 75-g OGTT 1.
- The development of Type 2 diabetes after pregnancy is related to ongoing insulin resistance and beta cell dysfunction, which were initially triggered or exacerbated by the hormonal changes of pregnancy, and both metformin and intensive lifestyle intervention can prevent or delay progression to diabetes in individuals with prediabetes and a history of gestational diabetes 1.
From the Research
Type of Diabetes after Pregnancy
The type of diabetes that occurs after pregnancy, not Gestational Diabetes (GD), is Type 2 Diabetes Mellitus (T2DM) 2, 3, 4, 5, 6.
Risk Factors
Several studies have demonstrated that women with a history of Gestational Diabetes Mellitus (GDM) face a substantially higher risk of developing T2DM compared to normoglycemic pregnant women 2, 3, 4, 5, 6. The most common risk factors associated with the progression of GDM to T2DM include:
- Pregnancy at an advanced age 3, 5
- Insulin treatment during pregnancy 2
- Delivering an overweight baby 2
- Family history of diabetes 3, 6
- Ethnic origin, such as Black and non-Hispanic White women 3
Incidence and Management
The incidence of T2DM after GDM is significant, with studies showing that women with GDM have an increased risk of developing T2DM compared to those who had a normoglycaemic pregnancy 4, 5, 6. 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 this population 2, 3, 6.
Key Findings
Key findings from the studies include:
- Women with GDM have an increased risk of developing T2DM, with a pooled unadjusted relative risk of 8.92 (95% CI, 7.84-10.14) 3
- The probability of diabetes developing after GDM was 3.7% at 9 months after delivery and 18.9% at 9 years after delivery 5
- The estimated hazard ratio for T2DM declined with time after a pregnancy with GDM but remained elevated for >35 years 6