Can We Predict the Insulin Therapy Need and Early Postpartum Prediabetes in Patients with Gestational Diabetes Mellitus?

Objective: The authors aimed to identify risk factors for insulin therapy need and for the development of postpartum prediabetes in women with gestational diabetes mellitus (GDM). Materials and methods: This was a prospective observational single-center study including pregnant women with GDM. Women with overt diabetes were excluded. Risk factors for insulin use and prediabetes were identified using logistic regression. Univariable analyses were performed to select factors for multivariable analysis. Stepwise logistic regression was used to create multivariable models. Results: Among 135 women with GDM, 63 (46.7%) required insulin therapy. Multivariable analysis demonstrated that family history of diabetes, abnormal pre-pregnancy body mass index (> 25 kg/m 2 ), the performance of 75 g oral glucose tolerance test (OGTT) before 24 Hbd, fasting plasma glucose (FPG) at pregnancy diagnosis constitute predictive factors for further insulin therapy need. Thirteen women (9.6%) developed prediabetes shortly (6–12 weeks postpartum) after gestation. In multivariable analysis family history of diabetes, rapid weight gain, 1 h plasma glucose (PG) in OGTT, 2 h PG in OGTT and glycated hemoglobin (HbA1c) concentration were identified as independent risk factors for prediabetes postpartum. Conclusions: Many easily-available parameters individually and combined in prediction models can be useful in assessing the risk of insulin therapy need and early postpartum prediabetes in women with GDM. Evaluation of the risk of above complications at GDM diagnosis is possible using metabolic parameters and family history of diabetes. (Clin Diabetol 2023; 12; 4: 223–231)