Prognosis

Subsequent pregnancies

GDM recurs in 30% to 84% of subsequent pregnancies.[17] Risk factors for GDM recurrence are older age, increased BMI, and higher weight gain between pregnancies.[95]

Development of type 2 diabetes

Women diagnosed with GDM are over 20 times more likely to go on to develop type 2 diabetes than the general population.[96] A European Society of Cardiology report highlighted that:[97]

  • An estimated 10% of women with GDM will have diabetes mellitus diagnosed soon after delivery with at least another 20% affected by impaired glucose metabolism at postnatal screening.

  • Of the remaining women, 20% to 60% will develop type 2 diabetes mellitus later in life, often within 5 to 10 years after the index pregnancy. The risk is greatest in the first year following delivery but persists for 25 years.[98]

Women with a history of GDM should therefore be screened regularly for type 2 diabetes, even late in life.[99]

A post-hoc analysis of the Diabetes Prevention Program in the US demonstrated that predominantly middle-aged women with a self-reported history of GDM had approximately a 50% reduction in the incidence of diabetes with an intensive lifestyle programme or the use of metformin.[100] Ten-year incidence is over 50%.[101] The risk of developing type 2 diabetes after GDM is roughly equivalent across ethnic groups.[102]

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