Postnatal glycaemic outcomes in women with high-risk gestational diabetes: Identifying key predictors for early intervention

Aims: Women with gestational diabetes (GDM) have increased lifetime risk of developing diabetes. We aim to determine the factors contributing to poor adherence of the postpartum oral glucose tolerance test (OGTT) and identify key predictors to postpartum dysglycaemia in our Asian cohort. Methods: We conducted a retrospective cohort study of women with high-risk GDM (n = 561). High-risk women with GDM were defined as (1) women with diabetic-range glucose excursions on an antepartum OGTT, (2) women diagnosed GDM on early OGTT and (3) women requiring ≥20 units of insulin during antepartum period. We use logistic regression predictive models to associate maternal variables with postpartum OGTT attendance and glucose tolerance status postnatally. Results: Between March 2020 to March 2024, 58.7% (n = 329) of women returned for postpartum OGTT. Predictors for attendance of postpartum OGTT were Chinese ethnicity (odds ratio [OR] 2.11, 95% confidence interval [CI] [1.14–3.89]), pre-pregnancy body mass index (BMI) (OR 0.95 [95% CI 0.90–0.99]), first GDM (OR 2.34 [95% CI 1.39–3.96]) and 2-h glucose threshold on antepartum OGTT (OR 0.87 [95% CI 0.76–0.99]). Ethnicity influences postnatal dysglycaemia outcomes in our cohort. Chinese women, compared to women of Malay ethnicity, had a 4.5-odds of persistent postpartum dysglycaemia. An antenatal HbA1c of ≥5.7% and an elevated 2-h post-OGTT glucose value significantly predict postpartum dysglycaemia independent of ethnicity. Conclusion: Ethnicity-specific prediction models integrating antepartum OGTT and HbA1c predict postpartum dysglycaemia in a multiethnic Southeast Asian cohort. Using these predictive models, we could identify high-risk patients for early intervention.