What type of diabetes is diagnosed postpartum?

From the Guidelines

Gestational diabetes that persists after pregnancy is typically classified as Type 2 diabetes, and women with a history of gestational diabetes mellitus should be screened for persistent diabetes or prediabetes at 4–12 weeks postpartum using nonpregnancy criteria, as recommended by the most recent guidelines 1.

Diagnosis and Classification

If blood sugar levels remain elevated after delivery, the woman is diagnosed with Type 2 diabetes. This occurs because the insulin resistance that developed during pregnancy does not resolve after childbirth.

Management

Management typically involves:

• Regular blood glucose monitoring
• Dietary changes to control carbohydrate intake
• Exercise (aim for 150 minutes per week)
• Medications if needed, such as metformin (starting dose 500mg twice daily) It's crucial to follow up with a healthcare provider within 4-12 weeks postpartum for glucose testing, as recommended by the American Diabetes Association 1. Early diagnosis and management can prevent complications associated with long-term diabetes.

Underlying Mechanism

The underlying mechanism involves persistent insulin resistance and/or inadequate insulin production by the pancreas, which can lead to chronically elevated blood sugar levels and damage various organs over time if left untreated.

Prevention and Screening

Women with a history of gestational diabetes mellitus should have lifelong screening for the development of type 2 diabetes or prediabetes every 1–3 years, and those with prediabetes should receive intensive lifestyle interventions and/or metformin to prevent diabetes, as recommended by the most recent guidelines 1. Breastfeeding is also recommended to reduce the risk of maternal type 2 diabetes 1.

From the Research

Type of Diabetes Diagnosed Postpartum

• The type of diabetes diagnosed postpartum is typically type 2 diabetes, as women with gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes later in life 2, 3, 4, 5.
• Studies have shown that women with GDM are nearly ten times more likely to develop type 2 diabetes than women with uncomplicated pregnancies 3.
• The risk of developing type 2 diabetes after GDM is substantial, with approximately 50% of mothers with GDM developing diabetes within 10 years 2.
• Type 1 diabetes can also occur after GDM, but it is less common, with a reported incidence of 5.7% in one study 4.

Predictors of Type 2 Diabetes Development

• Several factors have been identified as predictors of type 2 diabetes development in women with GDM, including:
  • Pre-pregnancy body mass index (BMI) 6
  • Gestational week of GDM diagnosis 6
  • Need for insulin therapy during pregnancy 6
  • Obesity 6
  • Plasma glucose levels at 60 minutes during an oral glucose tolerance test (OGTT) 6
  • Fasting and post-prandial plasma glucose levels one year after pregnancy 6

Postpartum Screening and Follow-up

• Women with GDM should be intensively monitored for a decade after pregnancy, as the risk of type 1 diabetes is minimal after this period, but the incidence of type 2 diabetes remains linear 4.
• Systematic follow-up programs are ideal to prevent progression of GDM to diabetes, but such programs are often lacking in routine clinical settings 2.