Is Everything all Right for "Diabetes Moms" After Child Delivery? No, the Real Danger is Still Ahead of You!

2019.08.22

Many "diabetes mothers" with gestational diabetes always look forward to the end of pregnancy to get rid of their diabetes. But the situation often backfired. Scientists have shown that women with gestational diabetes mellitus (GDM) have a greater chance of developing type 2 diabetes mellitus(T2DM) after delivery.

Gestational Diabetes Contribute to the Type 2 Diabetes

The so-called gestational diabetes refers to the fact that women have abnormal glucose metabolism and have diabetes during the special period of pregnancy. They have had pretty normal health levels before the pregnancy. For most women, although the blood sugar level returns to normal after the end of their pregnancy, gestational diabetes mellitus actually increases the risk of developing type 2 diabetes and becomes an unseen health hazard.

A systematic review by Lamy et al. showed that women with a history of gestational diabetes could have a risk of developing diabetes 7.43 times higher than women without a history of gestational diabetes. Her-ath et al and Bao et al showed that women with a history of gestational diabetes could have a 10-fold risk of developing type 2 diabetes within 10-20 years compared with average people.

In addition, a prospective German study [4] showed that the morbidity of diabetes could be as high as 63.6 per cent within the 15 years following gestational diabetes, with a median time lap of 7.9 years afterwards and a median age of 34 years old. Das et al [5] systematically evaluated the previously published literature, and found that during the 5-year postpartum follow-up of women with gestational diabetes, the incidence of diabetes was 7% ~ 84% and the incidence grew as they aged.

Therefore, women with gestational diabetes should monitor their blood glucose for a long time after delivery, at least for 10 years, instead of 1 year. For their own health, women have to fight against this battle of blood sugar for a long period.

Relationship Between Gestational Diabetes and Type 2 Diabetes Revealed

Type 2 diabetes can be a follow-up to gestational diabetes. The causes and internal mechanisms of the two are very similar. Gestational diabetes is the result of a combination of insulin resistance and islet B cell dysfunction. At the same time, insulin resistance and islet B cell dysfunction are recognized as the pathophysiological basis of type 2 diabetes. Therefore, gestational diabetes patients have an increased risk of developing type 2 diabetes after delivery. They are a high-risk group of developing type 2 diabetes afterwards.

In addition, the age of childbirth is also the key to connecting the two. The childbearing age is a risk factor for gestational diabetes and subsequent diabetes. According to Bener et al. the morbidity of gestational diabetes varies among pregnant women of different ages. The morbidity rates of <25 years old, 25 to 34 years old, and 35 to 45 years old were 13.4%, 41.6%, and 45%, respectively.

The morbidity of type 2 diabetes is also related to age. Its incidence of morbidity increases with age, consistent with the trend of gestational diabetes, both of which have higher prevalence rates over age. Gestational diabetes is inherently prone to induce postpartum type 2 diabetes. Combined with the high-risk age factor of type 2 diabetes, it is even more likely to induce type 2 diabetes.

Contributors to Type 2 Diabetes

What are the causes of type 2 diabetes after gestational diabetes mellitus? Studies have shown that BMI>24 kg/m2 before pregnancy, family history of diabetes, TG>1.2 mmol/L in the second trimester, and serum selenoprotein P>2.69 mmol/L are independent risk factors for abnormal glucose metabolism after giving birth.

In addition, gestational diabetes with metabolic syndrome, or metabolic syndrome developed after gestational diabetes are also risk factors. They may cause type 2 diabetes after several years. Studies have shown that gestational diabetic women with early postpartum combined with metabolic syndrome is a risk factor for postpartum type 2 diabetes, leading to an increased risk of 4.17 times. And the insulin resistance and B-cell function decrease more significantly among gestational diabetes patients with metabolic syndrome, suggesting that metabolic syndrome can further increase insulin resistance and decrease B-cell function, thereby contributing to the development of postpartum diabetes mellitus.

Preventing Gestational Diabetes from Inducing Type 2 Diabetes

The Control is in Your Hand

If you have had gestational diabetes during pregnancy and want to stay away from diabetes after child delivery, you must first strictly control your weight. You should eat properly during pregnancy and postpartum period, get quantitative supplement of vitamins, exercise properly, maintain a good schedule, and avoid over-nutrition, etc. In short, the purpose is to promote metabolism. In addition to these conventional preventive measures, the most effective way for gestational diabetes mothers is breastfeeding when their postpartum blood glucose returns to normal.

The study found that postpartum lactation can effectively reduce the incidence of postpartum type 2 diabetes. With lactation, the mother's body can utilize glucose more effectively, reduce fat synthesis, lose weight, weaken insulin resistance, make the body recover faster, prevent damage of pancreatic islet function, thus reducing the risk of developing type 2 diabetes.

We suggest that women with gestational diabetes must monitor their blood sugar after childbirth regularly. It should be tested every three months in the first year after delivery, and at least once a year after the first year. You may get in trouble if you are careless.

References

[1] Bellamy L，Casas J，Hingorani AD，et al． Type 2 diabetes mellitus after gestational diabetes:a systematic review and meta-analysis［J］． Lance，2009，373(9677):1773 －1779．

[2] Herath H，Herath Ｒ，Wickremasinghe Ｒ． Gestational diabetes mel-litus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women-A community based Ｒetrospective cohort study［J］． PLoSONE，2017，12(6):e0179647．

[3] Bao W，Yeung E，Tobias DK，et al． Long-term risk of type 2 diabetes mellitus in relation to BMI and weight change among women with a history of gestational diabetes mellitus:a prospective cohort study［J］．Diabetologia，2015，58(6):1212 －1219．

[4] Ziegler AG，Wallner M，Kaiser I，et al． Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus［J］．Diabetes，2012，61(12):3167 －3171．

[5] Das Gupta Ｒ，Gupta S，Das A，et al． Ethnic predisposition of diabetes mellitus in the patients with previous history of gestational dia-betes mellitus:a review［J］．Expert Ｒev Endocrinol Metab，2018，13(3):149 －158．

[6] Friedm an JE ，K irwan Jp ，Jing M ，et a1．Increased skeletal muscle tum or necrosis factor ——alpha and im p aired in sulin sig—。naling persist in obese w om en w ith gestatio nal diabetes m elli—tus 1 year postpartum ．D iabetes，2008 ，57 ：606 —613．

[7] Bener A，Saleh NM，Al-Hamaq A．Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons［J］．Int J Womens Health，2011，3(3):367 －373．

[8] ］ Cho NH，Ahn CH，Moon JH，et al． Metabolic syndrome independently predicts future diabetes in women with a history of gestational diabetes mellitus［J］． Medicine ，2016，95:35(e4582)．

[9] Cho NH，Ahn CH，Moon JH，et al． Metabolic syndrome independently predicts future diabetes in women with a history of gestational diabetes mellitus［J］．Medicine，2016，95(35):e4582．