Longer Interpregnancy Interval Is Associated with Gestational Diabetes Mellitus Recurrence

Tzuria Peled; Daniella Federmesser; Eyal Mazaki; Hen Y. Sela; Sorina Grisaru-Granovsky; Misgav Rottenstreich

doi:10.1055/a-2480-5407

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2025; 42(10): 1249-1256
DOI: 10.1055/a-2480-5407

Original Article

Longer Interpregnancy Interval Is Associated with Gestational Diabetes Mellitus Recurrence

Authors

Tzuria Peled^*

¹Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
Daniella Federmesser^*

²Department of Military Medicine and “Tzameret,” Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

³Medical Corps, Israel Defense Forces, Israel
Eyal Mazaki

¹Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
Hen Y. Sela

¹Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
Sorina Grisaru-Granovsky

¹Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
Misgav Rottenstreich

¹Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel

Abstract

Objective

This study aimed to evaluate the effect of interpregnancy interval (IPI) on the gestational diabetes mellitus (GDM) recurrence rate in the subsequent pregnancies following an initial pregnancy complicated by GDM.

Study Design

A multicenter, retrospective cohort study was conducted. The study included women diagnosed with GDM during their index pregnancy who subsequently delivered between 26 and 42 weeks of gestation from 2005 to 2021. The study population was categorized into eight groups according to their IPIs: up to 3, 3–5, 6–11, 12–17, 18–23, 24–35, 36–47, and over 48 months. We examined the recurrence rate of GDM in the different groups while comparing it to the 18–23-month group that was defined as the reference group. Statistical analyses included univariate analyses and multiple logistic regression.

Results

Out of 3,532 women who were included in the study, 1,776 (50.3%) experienced GDM recurrence in subsequent pregnancy. The recurrence rate was 44.6% for women IPI <6 months, 42.6% for women IPI of 6–11 months, 48.0% for women IPI of 12–17 months, 49.7% for women IPI of 18–23 months, 58.0% for women IPI of 24–47 months, and 62.6% for women IPI above 48 months. Multivariable logistic regression revealed that IPIs of 24–47 months and over 48 months were significantly associated with higher recurrence rates as compared with the 18–23-month reference group (adjusted odds ratio [aOR], 95% confidence interval [CI]: 1.66 [1.04–2.64] and 3.15 [1.07–9.29], respectively). This analysis also revealed other independent risk factors for GDM recurrence, including medication-controlled GDM in the index pregnancy, obesity, maternal age, parity, and gravidity.

Conclusion

Longer IPIs (over 24 months) are associated with an increased risk of GDM recurrence in subsequent pregnancies. These findings suggest that clinicians should consider IPI while managing postpartum care and planning future pregnancies for women with a history of GDM.

Key Points

Longer IPIs (over 24 months) are associated with an increased risk of GDM recurrence.
Clinicians should consider IPI while managing postpartum care for women with a history of GDM.
GDM A1, obesity, maternal age, parity, and gravidity were found as risk factors for GDM recurrence.

Keywords

gestational diabetes - interpregnancy interval - recurrence - postpartum management - obesity - maternal age

Volltext

Referenzen

References
1 Johnson ST, Lynch B, Vallance J, Davenport MH, Gardiner PA, Butalia S. Sedentary behavior, gestational diabetes mellitus, and type 2 diabetes risk: where do we stand?. Endocrine 2016; 52 (01) 5-10
2 Zygmuny-Siembida E, Wróblewski H, Zimna A. et al. Gestational diabetes mellitus - pathogenesis, diagnosis, treatment and prognosis. Qual Sport 2023; 11: 11-15
3 Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018; 19 (11) 3342
4 Kumar S. Gestational diabetes mellitus. Kerala Med J 2009; 2 (04) 112-116
5 Egan AM, Enninga EAL, Alrahmani L, Weaver AL, Sarras MP, Ruano R. Recurrent gestational diabetes mellitus: a narrative review and single-center experience. J Clin Med 2021; 10 (04) 569
6 Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377: e067946
7 Lowe Jr WLJ, Scholtens DM, Lowe LP. et al; HAPO Follow-up Study Cooperative Research Group. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 2018; 320 (10) 1005-1016
8 Coustan DR. Gestational diabetes mellitus. Clin Chem 2013; 59 (09) 1310-1321
9 Hahn S, Körber S, Gerber B, Stubert J. Prediction of recurrent gestational diabetes mellitus: a retrospective cohort study. Arch Gynecol Obstet 2023; 307 (03) 689-697
10 Lau SL, Chung A, Kao J, Hendon S, Hawke W, Lau SM. Significant risk of repeat adverse outcomes in recurrent gestational diabetes pregnancy: a retrospective cohort study. Clin Diabetes Endocrinol 2023; 9 (01) 2
11 Wei X, Hu R, Gao Y, Yu Z, Zhang X. Risk factors for recurrence of gestational diabetes mellitus and its correlation with maternal and infant prognosis. Evid Based Complement Alternat Med 2022; 2022: 7237777
12 Wei Y, Juan J, Su R. et al. Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China. Chin Med J (Engl) 2022; 135 (06) 665-671
13 Kotzaeridi G, Blätter J, Eppel D. et al. Recurrence of gestational diabetes mellitus: to assess glucose metabolism and clinical risk factors at the beginning of a subsequent pregnancy. J Clin Med 2021; 10 (20) 4794
14 Buchanan TA, Xiang AH, Buchanan TA, Xiang AH. Gestational diabetes mellitus. JCI Insight 2005; 115 (03) 485-491
15 Singh SK, Rastogi A. Gestational diabetes mellitus. Diabetes Metab Syndr 2008; 2 (03) 227-234
16 Imam K. Gestational diabetes mellitus. Adv Exp Med Biol 2012; 771: 24-34
17 Mühlrad H, Björkegren E, Haraldson P, Bohm-Starke N, Kopp Kallner H, Brismar Wendel S. Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study. Sci Rep 2022; 12 (01) 17402
18 Tano S, Kotani T, Ushida T. et al. Annual body mass index gain and risk of gestational diabetes mellitus in a subsequent pregnancy. Front Endocrinol (Lausanne) 2022; 13: 815390
19 Chou JS, Packer CH, Mittleman MA, Valent AM. Association of interpregnancy interval and gestational diabetes mellitus. J Matern Fetal Neonatal Med 2022; 35 (26) 10545-10550
20 Song G, Wei Y, Juan J. et al. Risk factors for gdm in subsequent pregnancy among women without GDM history in China: a multicenter retrospective study. Matern Fetal Med 2022; 5: 9-15
21 Shrestha P, Mahato V, Karmacharya S. Effect of inter-pregnancy interval on maternal and fetal outcome. Nepal J Obstet Gynaecol 2020; 15: 58-61
22 Schwartz N, Nachum Z, Green MS. The prevalence of gestational diabetes mellitus recurrence–effect of ethnicity and parity: a meta-analysis. Am J Obstet Gynecol 2015; 213 (03) 310-317
23 Biron-Chantal T, Sela H, Gabbai Ben Ziv R. et al Position Paper number 16 - The Israeli Obstetrics and Gynecology Association. Accessed December 13, 2024 at: https://cdn.mednet.co.il/2023/07/%D7%A1%D7%95%D7%9B%D7%A8%D7%AA-%D7%94%D7%A8%D7%99%D7%95%D7%A0%D7%99%D7%AA.pdf
24 Louis JM, Bryant A, Ramos D, Stuebe A, Blackwell SC. American College of Nurse-Midwives and the National Association of Nurse Practitioners in Women's Health, American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Interpregnancy Care. Am J Obstet Gynecol 2019; 220 (01) B2-B18
25 American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol 2018; 131 (05) e140-e150
26 Schwartz N, Green MS, Yefet E, Nachum Z. Modifiable risk factors for gestational diabetes recurrence. Endocrine 2016; 54 (03) 714-722
27 Schwartz N, Nachum Z, Green MS. Risk factors of gestational diabetes mellitus recurrence: a meta-analysis. Endocrine 2016; 53 (03) 662-671
28 Wang YY, Liu Y, Li C. et al. Frequency and risk factors for recurrent gestational diabetes mellitus in primiparous women: a case control study. BMC Endocr Disord 2019; 19 (01) 22
29 Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care 2007; 30 (05) 1314-1319
30 Gebremedhin AT, Tessema GA, Regan AK, Pereira GF. Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study. BMJ Open 2021; 11 (12) e046962
31 Martínez-Hortelano JA, Cavero-Redondo I, Álvarez-Bueno C, Díez-Fernández A, Hernández-Luengo M, Martínez-Vizcaíno V. Interpregnancy weight change and gestational diabetes mellitus: a systematic review and meta-analysis. Obesity (Silver Spring) 2021; 29 (02) 454-464
32 Gebremedhin AT, Regan AK, Malacova E. et al. Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysis. BMJ Open 2018; 8 (08) e025008
33 Kwak SH, Kim HS, Choi SH. et al. Subsequent pregnancy after gestational diabetes mellitus: frequency and risk factors for recurrence in Korean women. Diabetes Care 2008; 31 (09) 1867-1871
34 Skajaa GO, Fuglsang J, Knorr S, Møller N, Ovesen P, Kampmann U. Changes in insulin sensitivity and insulin secretion during pregnancy and post partum in women with gestational diabetes. BMJ Open Diabetes Res Care 2020; 8 (02) e001728
35 Dennison RA, Griffin SJ, Usher-Smith JA, Fox RA, Aiken CE, Meek CL. “Post-GDM support would be really good for mothers”: a qualitative interview study exploring how to support a healthy diet and physical activity after gestational diabetes. PLoS One 2022; 17 (01) e0262852
36 Zhang L, Wang F, Tashiro S, Liu PJ. Effects of dietary approaches and exercise interventions on gestational diabetes mellitus: a systematic review and Bayesian network meta-analysis. Adv Nutr 2024; 15: 100330
37 Tsoi KY, Chan RCM, Zhang C, Tam WH, Ma RCW. A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus. Int J Gynaecol Obstet 2024; 166 (03) 1170-1182
38 American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: standards of care in diabetes-2024. Diabetes Care 2024; 47 (Suppl. 01) S282-S294