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Nearly 1 in 5 Black women and 1 in 6 Latina women who experience gestational diabetes mellitus (GDM) during pregnancy are diagnosed with type 2 diabetes within only 8 years postpartum, according to a study poster at the American Diabetes Association (ADA) virtual conference.
“The true number is likely even larger because our study only measured diagnosed type 2 diabetes,” said principal investigator Teresa Janevic, PhD, MPH, associate director of the Blavatnik Family Women’s Health Research Institute, which is sponsored by the Ichan School of Medicine at Mount Sinai in New York City.
“Women who are never tested for diabetes would not show up in our study as a case.”
Janevic noted that women with GDM are at increased risk of developing type 2 diabetes, a leading cause of premature mortality. “While data suggest racial/ethnic minority women bear the disproportionate burden of GDM, current postpartum GDM cohorts lack adequate diversity to examine whether racial/ethnic disparities persist in the transition to type 2 diabetes,” Janevic said.
To address this gap, the investigators culled 2 New York City public health surveillance databases to construct a novel population-based cohort of women with gestational diabetes who gave birth between 2009 and 2011. The women were then followed for up to 8 years using linked New York City vital statistics and HbA1c diabetes registry data.
Of 16,231 women with gestational diabetes, the cumulative incidence of type 2 diabetes in 8 years of follow-up was 14.4% (n = 2,333 cases).
Among GDM cases, 18.2% of type 2 diabetes cases occurred in non-Hispanic Black women, 14.0% in Hispanic women, 11.3% in Asian women, and 5.5% in non-Hispanic White women.
“One preliminary finding that surprised me is that the risk of type 2 diabetes was higher among immigrant women,” Janevic told Contemporary OB/GYN®. “We have previously seen this in studies of gestational diabetes; however, no one has detected this disparity in postpartum diabetes. If the finding holds with more detailed analyses, it suggests that immigrant women are an important patient population to target in postpartum interventions to prevent type 2 diabetes.”
The study indicates that more attention should be focused on the long-term postpartum follow-up of women with gestational diabetes, particularly women of color, according to Janevic. “Although awareness has recently been raised about the importance of follow-up of gestational diabetes in the immediate postpartum period of 4 to 12 weeks, clinicians may be less aware that the ADA recommends that women with a history of GDM should have lifelong screening for the development of type 2 diabetes or prediabetes at least once every 3 years,” she said. “Because ob-gyns often serve as a primary point of care for women, they have the potential to play an active role in this lifelong follow-up.”
Future analysis of the diverse cohort will further examine racial/ethnic disparities in disease progression among women with gestational diabetes, such as from diabetes to glycemic control, “which has not been well studied in prior cohorts,” said Janevic, who also is an associate professor of ob-gyn and reproductive science at the Ichan School of Medicine at Mount Sinai. “By identifying what is fueling these disparities, not only among patients but also in neighborhoods, health systems and health policies, we can better target interventions to reduce disparities.”
Janevic reports no relevant financial disclosures.