Abstract：
OBJECTIVE: To determine risk factors for 1-year postpartum weight retention (PPWR) and glucose intolerance (prediabetes + diabetes) in women with a previous history of gestational diabetes (GDM) and prediabetes in early postpartum.
METHODS: In this exploratory analysis of the MELINDA randomized controlled trial, we report data of 167 women with prediabetes at the 6-16 weeks (early) postpartum oral glucose tolerance test after a recent history of GDM.
RESULTS: Of all participants, 45% (75) had PPWR >0 kg at 1-year postpartum. Compared to women without PPWR, women with PPWR had higher gestational weight gain [10.5 ± 6.4 vs. 6.5 ± 4.5 kg, p < 0.001], higher BMI (p < 0.01) and a worse metabolic profile (higher waist circumference, worse lipid profile and more insulin resistance) (all p < 0.05) both in early and late postpartum. Of all women with PPWR, 40.0% developed metabolic syndrome, compared to 18.9% of women without late PPWR (p = 0.003). The only independent predictor for late PPWR was weight retention in early postpartum (p < 0.001). Of all participants, 55.1% (92) had glucose intolerance (84 prediabetes, 8 diabetes) 1-year postpartum. Independent predictors for late postpartum glucose intolerance were lower gestational age at start insulin therapy in pregnancy and delivery by caesarean section (resp. p = 0.044 and 0.014).
CONCLUSIONS: In women with a previous history of GDM and prediabetes in early postpartum, PPWR in early postpartum was a strong independent predictor for late PPWR, while earlier start of insulin therapy during pregnancy and delivery by caesarean section were independent predictors of glucose intolerance in late postpartum.
METHODS: In this exploratory analysis of the MELINDA randomized controlled trial, we report data of 167 women with prediabetes at the 6-16 weeks (early) postpartum oral glucose tolerance test after a recent history of GDM.
RESULTS: Of all participants, 45% (75) had PPWR >0 kg at 1-year postpartum. Compared to women without PPWR, women with PPWR had higher gestational weight gain [10.5 ± 6.4 vs. 6.5 ± 4.5 kg, p < 0.001], higher BMI (p < 0.01) and a worse metabolic profile (higher waist circumference, worse lipid profile and more insulin resistance) (all p < 0.05) both in early and late postpartum. Of all women with PPWR, 40.0% developed metabolic syndrome, compared to 18.9% of women without late PPWR (p = 0.003). The only independent predictor for late PPWR was weight retention in early postpartum (p < 0.001). Of all participants, 55.1% (92) had glucose intolerance (84 prediabetes, 8 diabetes) 1-year postpartum. Independent predictors for late postpartum glucose intolerance were lower gestational age at start insulin therapy in pregnancy and delivery by caesarean section (resp. p = 0.044 and 0.014).
CONCLUSIONS: In women with a previous history of GDM and prediabetes in early postpartum, PPWR in early postpartum was a strong independent predictor for late PPWR, while earlier start of insulin therapy during pregnancy and delivery by caesarean section were independent predictors of glucose intolerance in late postpartum.
摘要：
目的：确定有妊娠糖尿病（GDM）和糖尿病前期病史的妇女产后1年体重滞留（PPWR）和葡萄糖耐受不良（糖尿病前期+糖尿病）的危险因素。
方法：在对MELINDA随机对照试验的探索性分析中，我们报告了167名糖尿病前期女性在近期GDM病史后进行的6~16周(早期)产后口服葡萄糖耐量试验的数据.
结果：在所有参与者中，45％（75）的PPWR>0kg在产后1年。与没有PPWR的女性相比，PPWR妇女的妊娠期体重增加较高[10.5±6.4vs.6.5±4.5kg,p<0.001],较高的BMI(p<0.01)和较差的代谢特征(较高的腰围，在产后早期和晚期，血脂状况恶化和胰岛素抵抗增加）（所有p<0.05）。在所有患有PPWR的女性中，40.0%发展为代谢综合征,相比之下，没有晚期PPWR的女性为18.9%(p=0.003)。晚期PPWR的唯一独立预测因素是产后早期体重滞留(p<0.001)。在所有参与者中，55.1%(92)有葡萄糖不耐受(84例糖尿病前期，8例糖尿病)产后1年。产后晚期葡萄糖不耐受的独立预测因素是在怀孕和剖宫产分娩时开始胰岛素治疗时孕龄较低（分别p=0.044和0.014)。
结论：在产后早期有GDM和糖尿病前期病史的女性中，产后早期PPWR是晚期PPWR的强独立预测因子,而妊娠期间较早开始胰岛素治疗和剖宫产分娩是产后晚期葡萄糖耐受不良的独立预测因素。
方法：在对MELINDA随机对照试验的探索性分析中，我们报告了167名糖尿病前期女性在近期GDM病史后进行的6~16周(早期)产后口服葡萄糖耐量试验的数据.
结果：在所有参与者中，45％（75）的PPWR>0kg在产后1年。与没有PPWR的女性相比，PPWR妇女的妊娠期体重增加较高[10.5±6.4vs.6.5±4.5kg,p<0.001],较高的BMI(p<0.01)和较差的代谢特征(较高的腰围，在产后早期和晚期，血脂状况恶化和胰岛素抵抗增加）（所有p<0.05）。在所有患有PPWR的女性中，40.0%发展为代谢综合征,相比之下，没有晚期PPWR的女性为18.9%(p=0.003)。晚期PPWR的唯一独立预测因素是产后早期体重滞留(p<0.001)。在所有参与者中，55.1%(92)有葡萄糖不耐受(84例糖尿病前期，8例糖尿病)产后1年。产后晚期葡萄糖不耐受的独立预测因素是在怀孕和剖宫产分娩时开始胰岛素治疗时孕龄较低（分别p=0.044和0.014)。
结论：在产后早期有GDM和糖尿病前期病史的女性中，产后早期PPWR是晚期PPWR的强独立预测因子,而妊娠期间较早开始胰岛素治疗和剖宫产分娩是产后晚期葡萄糖耐受不良的独立预测因素。
