Blood Sugar Control and Diabetes Risk are Affected by Gestational Diabetes

According to a Mount Sinai study that was published on June 21 in the journal Diabetes Care, people who develop diabetes after pregnancy were significantly less likely to be able to bring it under control if they had experienced gestational diabetes during their pregnancy, especially if they were Black or Hispanic.

The study also found that people who had gestational diabetes were more than 11 times more likely to develop diabetes within nine years of giving birth than people whose pregnancies did not involve gestational diabetes.

The Icahn School of Medicine at Mount Sinai’s researchers discovered that the first 12 weeks to one year after giving birth had the highest diabetes incidence and the lowest likelihood of diabetes control. According to the findings, regular diabetes screenings, particularly in the early postpartum period, may be able to alter the rate and course of disease progression in the years to come, according to the researchers.

Type 2 diabetes, also known as adult-onset diabetes, and gestational diabetes are two of the most common risk factors for cardiovascular disease. Additionally, both conditions are marked by persistent racial and ethnic disparities, which frequently arise as a result of gaps in access to treatment and medical care. While a lot of research has looked at how gestational diabetes affects type 2 diabetes in later life, very little has looked at how gestational diabetes affects the severity of the disease or how well it is controlled once diabetes is diagnosed.

The Mount Sinai researchers looked into how race, ethnicity, and gestational diabetes interact to affect both diabetes risk and glycemic control, or meeting clinical recommendations for blood sugar levels, in this study. People of South and Southeast Asian descent constituted the groups with the highest incidence of gestational diabetes, according to the findings of the researchers; Compared to other racial/ethnic groups, these groups had a slightly lower risk of diabetes after delivery, but the risk was still very high. The researchers discovered that a history of gestational diabetes was associated with greater difficulty controlling glucose levels among those who experienced diabetes after delivery. Black and Hispanic individuals, in particular, took longer than those without gestational diabetes to achieve glucose control among those with postpartum-onset diabetes following gestational diabetes.

Using data from 2009 to 2017, the team of researchers created a novel population-based cohort of more than 330,000 postpartum women in New York City to investigate how race and ethnicity influence diabetes risk and management in relation to gestational diabetes. Self-reported race and ethnicity, as well as sociodemographic characteristics like age, nativity, education, and insurance type or status, were included in the birth records. Other pregnancy-related comorbidities included gestational diabetes and gestational hypertensive disorders. The Mount Sinai researchers were able to build on the limited evidence of racial and ethnic differences in the influence of gestational diabetes and confirm prior estimates of diabetes risk attributed to gestational diabetes through their analysis. Policies like expanding Medicaid coverage for postpartum women are supported by the data because they both facilitate and expand access to health care after delivery.

“This study shows that a history of gestational diabetes is a red flag for higher risk of diabetes but also poorer control down the line, with Black and Hispanic women most affected,” said senior author Teresa Janevic, PhD, MPH, Associate Professor of Obstetrics, Gynecology and Reproductive Science, Population Health Science and Policy, and Global Health and Health Systems Design at Icahn Mount Sinai. “The good news is this red flag provides the opportunity for diabetes prevention, if we focus more intently on mom’s health in the first year postpartum.”

The Mount Sinai team will then build on their previous work by looking at how the neighborhood environment affects long-term diabetes outcomes after gestational diabetes. The goal is to find healthy policies that lower diabetes risk. This study was supported by the Department of Health and Mental Hygiene in New York City.