Postpartum Period and Gestational Diabetes: Does it Persist?
Persistent Gestational Diabetes Puts Mothers at Risk
Gestational diabetes, a type of diabetes that develops during pregnancy in individuals who did not previously have diabetes, can have lasting effects on a woman's health. If gestational diabetes continues after childbirth, it often evolves into type 2 diabetes (T2D), posing significant long-term risks.
Individuals who have gestational diabetes that persists after childbirth face a high risk of developing type 2 diabetes and related complications such as cardiovascular disease (CVD) and chronic hypertension.
Key long-term risks and complications include:
- High risk of subsequent type 2 diabetes: Women with gestational diabetes mellitus (GDM), especially those whose diabetes persists postpartum, have a substantially elevated risk of progressing to overt type 2 diabetes later in life. Preventing or delaying T2D onset is critical since it mediates much of the subsequent health risk.
- Increased cardiovascular disease risk: Women with prior GDM have a markedly increased chance of developing cardiovascular disease, which is often linked to progression to type 2 diabetes and chronic hypertension. Independent factors such as inflammation and endothelial dysfunction related to GDM may further increase CVD risk.
- Chronic hypertension: GDM is associated with a higher incidence of hypertensive disorders of pregnancy (HDP), which predisposes women to chronic hypertension and contributes to cardiovascular disease risk in long-term follow-up.
- Elevated risk of thyroid disorders: Women with GDM are more likely to develop or worsen thyroid conditions postpartum, including postpartum thyroiditis and hypothyroidism.
- Need for ongoing glucose monitoring postpartum: Because GDM can persist or evolve into permanent glucose intolerance, guidelines recommend retesting blood glucose at about six weeks postpartum to detect persistent diabetes. Ongoing monitoring and management are important to mitigate further complications.
- Potential for poor long-term metabolic and vascular health without management: The long-term impact can be mitigated by lifestyle changes and medical interventions focused on blood glucose control and modifiable risk factors, which have been shown to reduce progression to T2D and cardiovascular risk by over 90% when optimally controlled.
Around 10% of people who had gestational diabetes may develop type 2 diabetes 1-2 years after giving birth. To manage and prevent the development of T2D, it is essential to maintain regular blood sugar monitoring after delivery, take insulin as prescribed by a doctor, and follow a diet suitable for people with diabetes.
Moderate-intensity exercise for at least 30 minutes daily, such as walking or swimming, can help manage blood sugar levels postpartum. Nursing can also help increase the number of calories the body uses after delivery. Joining a diabetes prevention program, weight loss support group, or postpartum exercise group may provide additional support.
If you suspect you may have symptoms of diabetes after delivery, such as needing to urinate more frequently, increased thirst, feeling very hungry, unexplained weight loss, blurred vision, numbness or tingling in hands or feet, fatigue, dry skin, having more infections than is typical, sores or wounds healing slowly, or experiencing more fatigue, consult a healthcare professional immediately.
In the late stages of pregnancy, there is a significant increase in insulin resistance, which can lead to gestational diabetes. After giving birth, pregnancy hormone levels should rapidly decrease, resolving pregnancy-related insulin resistance in many people. However, for those with persistent gestational diabetes, ongoing monitoring and management are crucial to minimise long-term complications.
References:
[1] American Diabetes Association. (2021). Classification and Diagnosis of Diabetes.
[2] American College of Obstetricians and Gynecologists. (2021). Gestational Diabetes Mellitus: Screening and Diagnosis.
[3] American Diabetes Association. (2021). Gestational Diabetes Mellitus and Type 2 Diabetes in Later Life.
[4] American Thyroid Association. (2021). Postpartum Thyroiditis.
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