Recurrence of gestational diabetes: Who is at risk?

OBJECTIVE: The object was to determine the recurrence rate of gestational diabetes mellitus and to find various risk factors that might increase this rate. STUDY DESIGN: Seventy-eight patients with gestational diabetes mellitus in their index pregnancies were evaluated in subsequent pregnancies. Medical records for the index and subsequent pregnancies were abstracted for age, parity body mass index, birth weight, gestational age of gestational diabetes mellitus diagnosis, insulin requirement, weight gain, and interval between pregnancies. These variables were then compared between patients with and without gestational diabetes mellitus in their subsequent pregnancies. RESULTS: Fifty-four of 78 patients (69%) had gestational diabetes mellitus in a subsequent pregnancy. The recurrence of gestational diabetes mellitus was more common when the following variables were present in the index pregnancy: parity greater than or equal to 1 (P<.004; odds ratio 3.0, 95% confidence interval 1.4-4.8), body mass index greater than or equal to 30 kg/m(2) (P <.04; odds ratio 3.6, 95% confidence interval 1.1-25.9), gestational diabetes mellitus diagnosis at less than or equal to 24 gestational weeks (P <.0003; odds ratio 20.4, 95% confidence interval 2.5-444), and insulin requirement (P <.0002; odds ratio 2.3, 95% confidence interval 1.3-3.4). A weight gain of greater than or equal to 15 pounds (P <.003; odds ratio 2.9, 95% confidence interval 1.0-5.3) and an interval between pregnancies less than or equal to 24 months (P <.03; adds ratio 1.6, 95% confidence interval 1.1-2.2) were also associated with a recurrence of gestational diabetes mellitus. A multiple logistic regression analysis revealed that an interval of less than or equal to 24 months and a weight gain of greater than or equal to 15 pounds between pregnancies were most strongly correlated with a recurrence of gestational diabetes mellitus. CONCLUSIONS: Gestational diabetes mellitus is more likely to recur in parous, obese women who had an early gestational diabetes mellitus diagnosis and required insulin in the index pregnancy. In addition, a shorter interval (less than or equal to 24 months) and a larger weight gain (greater than or equal to 15 pounds) between pregnancies appear to be the most significant risk factors for a recurrence of gestational diabetes mellitus.