RISK OF TYPE II DIABETES FOLLOWING GESTATIONAL DIABETES IN TRIPOLILIBYA

Mohamed Sultan* and Ebtisam Dribika

ABSTRACT

Background: Gestational diabetes mellitus (GDM) is one of the more common disorders of pregnancy and its incidence increased progressively, its importance lies in its association with adverse pregnancy outcomes, and increased maternal risk of future diabetes but the exact incidence is widely variable globally, and the associated risk factors are not fully investigated. Objective: To estimate the proportion of mothers who transform from having GDM to type 2. DM within the puerperium and to determine the risk factors associated with increased chance to become frankly diabetic following pregnancy complicated by GDM. Patients & Methods: A longitudinal descriptive prospective study. 64 pregnant women diagnosed with GDM in the current pregnancy presented to diabetic pregnancy outpatient department (dpopd), Aljalaa Maternity Hospital, Tripoli-Libya in the period from April 2014 to April 2015.. After delivery, discontinue treatment of DM and assess the level of blood sugar weekly via serial blood sugar (SBS), fasting and two hours post prandial until six weeks post-delivery where DM confirmed or excluded via 75g oral glucose tolerance test (OGTT), Pregnant women with preexisting diabetes or discovered diabetic early in pregnancy with high HbA1c (which indicates unrecognized preexisting diabetes) were excluded from the study. Results: After 6 weeks of delivery, out of 64 patients diagnosed with GDM 22 (34.4%) converted to T2DM. Out of 37 patients whose age was ≥ 35 years 14(37.8%) became diabetic (mean age 34.7±5.3 y). From patients who had (B+) blood group 4 (44.4%) out of 9 patients were converted to T2DM. Out of 7 patients who were on insulin and metformin 3 (42.8%) became diabetic. Patients who had a positive family history of diabetes 8 (44.4%) out of 18 patients converted to T2DM. From patients whose BMI was ≥ 30 kg/m2 out of 55 patients 19 (34.5%) converted to T2DM. From patients whose HbA1c was more than 6%, we found that 13 (46.4%) out of 28 has been converted to T2DM. From patients who had hypothyroidism out of 9 patients 4(44.4%) converted to T2DM. From 15 patients who had ≥ 4 previous children, 9 (60%) became diabetic. Number of patients with history of polycystic ovary syndrome (PCOS) and converted to (T2DM) was 2 (50%) out of 4 patients. Mothers who had babies with large birth weight (≥ 4 kg) and converted to T2DM were 5 (50%) out of 10. Mothers who fed their babies from bottle were 29 patients, 12 (41.4%) converted to T2DM. Conclusion: About a third of pregnant women with GDM will become diabetic as early as 6 weeks post-delivery and may be more later on. The risk is increased with the advanced maternal age, having (B+) blood group, using of insulin during pregnancy, positive first degree relatives history of diabetes, BMI ≥ 30, HbA1c > 6% at the time of GDM diagnosis, patients with hypothyroidism, giving birth to a macrosomic baby, high parity, positive history of polycystic ovary syndrome (PCOS) and bottle feeding.

Keywords: Diabetes Mellitus, Gestational Diabetes Mellitus (GDM), Pregnancy.