Prognosis

Subsequent pregnancies

Gestational diabetes mellitus (GDM) recurs in 30% to 84% of subsequent pregnancies.[17] Risk factors for recurrence are older age, increased BMI, and higher weight gain between pregnancies.[114]

Development of type 2 diabetes

GDM is associated with an 8- to 10-fold increased risk of developing type 2 diabetes.[115][116]​ A European Society of Cardiology report highlighted that:[117]

  • An estimated 10% of women with GDM will be diagnosed with diabetes soon after delivery, with at least another 20% found to have impaired glucose metabolism at postnatal screening.

  • Of the remaining women, 20% to 60% will develop type 2 diabetes later in life, often within 5 to 10 years of the index pregnancy. The risk is greatest in the first year following delivery, but persists for 25 years.[118]

Women with a history of GDM should therefore be screened regularly for type 2 diabetes, even later in life.[119]

A post-hoc analysis of the Diabetes Prevention Program in the US showed that women (predominantly middle-aged) with a self-reported history of GDM had about a 50% reduction in diabetes incidence with either an intensive lifestyle programme or metformin, compared with placebo.[120] A meta-analysis estimated that among women with a history of GDM, the risk of developing type 2 diabetes after GDM is approximately 20% after 10 years, rising to nearly 60% after 50 years; in some cohorts, 10-year incidence exceeds 50%.[121] This risk appears broadly consistent across ethnic groups.[116]

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