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Purpose We aimed to evaluate the prevalence of postpartum diabetes among women with a history of overt diabetes in pregnancy (ODiP) and compare with women having a history of gestational diabetes mellitus (GDM) and normoglycemia in pregnancy. Methods We have an established longitudinal cohort of postpartum women with a history of hyperglycemia (preexisting diabetes [PED] [n = 101], ODiP [n = 92], GDM [n = 643]), and normoglycemia (n = 183) in pregnancy. For this study, we excluded women with PED and invited other eligible women in a fasting state for clinical and biochemical evaluation. Results We evaluated 918 women with a mean (SD) age of 33.6 (5.0) years and at a median (interquartile range) postpartum interval of 31 (20–45) months. Diabetes was diagnosed in 65 (70.7%) women in ODiP compared to 99 (15.4%) in GDM (p < .001) and 4 (2.2%) in normoglycemia group (p < .001). In the ODiP group, the prevalence of diabetes was 47.4% among women tested in the first year postpartum, increasing to 86.8% among women tested at >3 years postpartum. Diabetes was more common when ODiP was diagnosed in the first (27/29, 93.1%) compared to the second trimester of pregnancy (35/57, 61.4%). The adjusted odds ratio for diabetes in ODiP was 14.82 (95% confidence interval, 8.49–25.87; p < .001; reference category: GDM). Conclusions The prevalence of postpartum diabetes was significantly higher in women with ODiP compared to GDM. Nearly 50% of women with ODiP did not develop diabetes in the first year of follow‐up, especially when ODiP was diagnosed after the first trimester of pregnancy and on the basis of a 2‐h oral glucose tolerance test value. Such women are amenable to prevention strategies. Highlights We evaluated the prevalence of postpartum diabetes among women with overt diabetes in pregnancy (ODiP). Diabetes was diagnosed in 65 (70.7%) women with ODiP at a median postpartum interval of 29 months. The prevalence of diabetes in the ODiP group was 47.4% among women tested in the first year postpartum, increasing to 86.8% among women tested at >3 years postpartum. Postpartum diabetes was more common when ODiP was diagnosed in the first (27/29, 93.1%) trimester of pregnancy. Postpartum diabetes was more common when ODiP was diagnosed based on glycated hemoglobin (HbA1c) elevation before 15 weeks of gestation (19/20, 95.0%).

Background Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes. Methods This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD). Maternal delivery records were linked to their respective birth records from 2006 to 2019. The prevalence of T1DM, T2DM and GDM were calculated, including relative changes over time, assessed by a Cochrane-Armitage test. Also assessed were differences between provinces and territories in the prevalence of DM. Results Over the 15-year study period, comprising 4,320,778 hospital deliveries in Canada, there was a statistically significant increase in the prevalence of GDM and T1DM and T2DM. Compared to pregnancies without DM, all pregnancies with any form of DM had higher rates of hypertension and Caesarian delivery, and also adverse infant outcomes, including major congenital anomalies, preterm birth and large-for-gestational age birthweight. Conclusion Among 4.3 million pregnancies in Canada, there has been a rise in the prevalence of DM. T2DM and GDM are expected to increase further as more overweight women conceive in Canada.

Background Early identification of individuals at risk for gestational diabetes mellitus (GDM) is essential for mitigating its adverse effects on both maternal and foetal health. This study aimed to evaluate the predictive value of the cardiometabolic index (CMI), systemic inflammation response index (SIRI), and serum adipsin levels for GDM. Methods A total of 1660 pregnant women were enrolled in this study conducted in Suzhou, China. Baseline clinical data, including blood glucose levels, lipid profiles, and blood cell counts, were collected at 12 weeks of gestation. GDM was diagnosed between 24 and 28 weeks of gestation. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the associations and predictive performance of CMI, SIRI, and adipsin for GDM. Results Compared with non-GDM participants, those with GDM exhibited significantly higher CMI and SIRI values and lower serum adipsin levels at baseline. Increased CMI and SIRI, as well as reduced adipsin levels, were independently associated with a higher risk of GDM in both unadjusted and adjusted models (all P  < 0.05). The composite model incorporating all three biomarkers achieved a higher area under the curve (AUC) of 0.918 compared with the individual models for CMI (AUC = 0.825), SIRI (AUC = 0.802), and adipsin (AUC = 0.724). Conclusions CMI, SIRI, and serum adipsin are independently associated with GDM risk, and their combination provides a promising multi-biomarker strategy for early GDM prediction. Further studies are needed to validate these findings in diverse populations. Graphical Abstract

Aims Overt diabetes in pregnancy is defined as hyperglycemia first recognized during pregnancy which meets the diagnostic threshold of diabetes in non-pregnant adults. This case-based narrative review aims to describe this unique condition and discuss the potential implications for its accurate diagnosis and management. Methods and Results We conducted a literature search in PubMed for relevant articles published in English language up to January 2022. Women with overt diabetes have a higher risk for adverse pregnancy outcomes and postpartum diabetes, compared to their counterparts with gestational diabetes mellitus (GDM). Such women often need aggressive management, including early and prompt initiation of insulin therapy, and a close follow-up during pregnancy and in the postpartum period. Not all pregnant women with overt diabetes have persistent diabetes in the postpartum period. Early diagnosis, especially during the first trimester, and fasting plasma glucose elevation (≥ 126 mg/dl or 7 mmol/L) at the time of initial diagnosis are predictors of postpartum diabetes. Conclusions Both GDM and overt diabetes in pregnancy are hyperglycemic conditions first recognized during pregnancy, but the two conditions differ in severity; the latter is a more severe form of hyperglycemia associated with worse maternal and fetal outcomes, and a higher risk of postpartum diabetes.

Purpose of ReviewTo review current glycaemic targets and the potential use of newer insulin formulations in pregnancy.Recent FindingsThe impact of stricter glycaemic control on perinatal outcomes remains controversial, showing conflicting results. Current ongoing randomised trials investigating the role of tighter glucose targets in pregnancy should help clarify the benefit of tighter glucose control. Optimal timing for self-monitoring blood glucose (SMBG) remains debatable. Data suggest that post-prandial SMBG, particularly at 1 h, offers the best prediction of adverse perinatal outcome. To achieve these targets, insulin is the standard therapy. Novel insulin formulations offer benefits outside of pregnancy. Recent data on the use of new insulins in pregnancy (e.g. insulin degludec and glargine (U 300)) is limited to case reports.SummaryGlycaemic targets have remained unchanged in the last decade. Studies using stricter glycaemic targets may improve perinatal outcomes. Newer insulin formulations may offer increased flexibility and glycaemic control. Clinicians caring for women with diabetes striving to minimise adverse perinatal outcomes will find this review of interest.

Purpose of ReviewThe purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy.Recent FindingsThe latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy.SummaryEmerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensor-integrated insulin delivery.

We aimed to examine the impact of a preconception pro-inflammatory diet on gestational diabetes mellitus (GDM) using singleton pregnancy data from the Japan Environment and Children’s Study involving live births from 2011 to 2014. Individual meal patterns before pregnancy were used to calculate the dietary inflammatory index (DII). Participants were categorized according to DII quartiles 1–4 (Q1 and Q4 had the most pro-inflammatory and anti-inflammatory diets, respectively). The participants were stratified into five groups by pre-pregnancy body mass index (BMI): G1 to G5 (<18.5 kg/m2, 18.5 to <20.0 kg/m2, 20.0 to <23.0 kg/m2, 23.0 to <25.0 kg/m2, and ≥25.0 kg/m2, respectively). A multiple logistic regression model was used to estimate the effect of the anti-inflammatory diet on GDM, early diagnosed (Ed)-GDM, and late diagnosed (Ld)-GDM in each BMI group. Trend analysis showed that the risk of GDM, Ed-GDM, and Ld-GDM increased with increased pre-pregnancy BMI values. In the G4 group, the risk of Ed-GDM increased in Q2 and Q4. This study suggests that, although higher maternal BMI increases the risk of GDM, the effect of a preconception pro-inflammatory diet on the occurrence of GDM depends on pre-pregnancy BMI. This result may facilitate personalized preconception counseling based on maternal BMI.

Introduction Gestational diabetes mellitus (GDM) is a transient hyperglycemic condition identified during pregnancy in women without a history of chronic diabetes. GDM prevalence varies in different populations and is high among pregnant women of Asia–Pacific islanders compared with others like Europeans. GDM mothers could be categorized into different glycemic intolerance phenotypes involving various combinations of insulin sensitivity and insulin resistance, that could lead to different short-term and long-term maternal and offspring outcomes, independent of known risk factors of GDM. We hypothesize that identification of these heterogenous phenotypes offers better opportunities for more effective and precise treatments in preventing GDM-related adverse outcomes. The GDM-CARE study aims to evaluate glycemic profiling recorded via a continuous glucose monitoring (CGM) device and cardio-metabolic biomarkers alteration that determine different GDM phenotypes and their specific treatment responses. Methods and analysis The GDM-CARE study enrollment began in 2022. Research visits will be conducted at three time points: baseline (5–13 weeks of gestation), visit 1 (15–30 weeks of gestation), and visit 2 (34–36 weeks of gestation, only for GDM participants). Blood and fecal samples, medical record, anthropometric and blood pressure measurements will be collected, CGM will be worn for 7–14 days, and questionnaires will be completed. The effect size across five groups would be more than 0.60, targeting 800 subjects to be recruited. The sample size of 200 GDM and overweight/obese subjects can detect a difference of 0.3 effect size across five groups with 80% power, 0.5% type-I error and 10% drop-out rate. Student’s t-test, Mann–Whitney U test, chi-square test, and Fisher’s exact test will be applied, based on the distribution or scale of the variables. The effects sizes will be reported as estimates (β) or relative risk with a 95% confidence interval (CI), using multiple linear regression or Modified Poisson Regression, after adjusting for key confounders. The two-sided p value will be set at significance if less than 0.05. Discussion We anticipate that our study would enable us to: (1) differentiate GDM phenotypes with various combinations of insulin resistance and -cell dysfunction by applying glycemic profiling, cardio-metabolic profiling, and metabolites profiling; (2) study the GDM phenotype-specific treatment response.

Background Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research. Methods We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool. Results Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care. Conclusions Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health. Protocol Registration This review was registered in PROSEPRO (CRD42023454900).

Aims/Introduction To summarize the development of the criteria for diagnosing gestational diabetes mellitus (GDM) in China, and investigate how different GDM diagnostic criteria influence the national prevalence of GDM, the national health system and the economic burden of GDM in China. Materials and Methods Retrospectively using data from women undergoing a 2‐h, 75‐g oral glucose tolerance test at 24–28 gestational weeks in the First Affiliated Hospital of Jinan University (Guangzhou, Guangdong, China) from January 2011 to December 2017, the prevalence rate of GDM and its impacts on the national health system were evaluated using different criteria (the 7th edition textbook criteria, National Diabetes Data Group 1979, World Health Organization 1985, European Association for the Study of Diabetes 1996, Japan 2002, American Diabetes Association [ADA] 2011 [International Association of the Diabetes and Pregnancy Study Groups], and National Institute for Heath and Care Excellence 2015). Results The incidence rates of GDM based on the ADA 2011 and National Institute for Heath and Care Excellence 2015 were, respectively, 22.94% (P < 0.01) and 21.72% (P < 0.01), over threefold higher than implementing the 7th edition textbook criteria (P < 0.001). On the contrary, the incidence rates of GDM diagnosed with the National Diabetes Data Group 1979 and World Health Organization 1985 guidelines were significantly less than the 7th edition textbook criteria (P < 0.001). From 2001 to 2016, the estimated national cost of treating GDM rose from ¥3.9 billion to ¥27.4 billion after implementing the ADA 2011 guidelines. Conclusions With the implementation of ADA 2011 (International Association of the Diabetes and Pregnancy Study Groups) guidelines, there are fewer adverse perinatal outcomes and cases of type 2 diabetes mellitus in the long term, but the medical costs increased significantly, and the cost‐effectiveness of diagnostic criteria in China is still yet to be confirmed. A retrospective research on 12324 singleton pregnant in China to investigate the influence on the prevalence of GDM and the economic burden of applying new diagnostic guidelines.