7.3.0.0 Ges­ta­tion­al Di­a­betes Mel­li­tus & T2D

Women with a his­to­ry of GDM have a great­ly in­creased risk of con­ver­sion to type 2 di­a­betes over time (81). In the prospec­tive Nurs­es’ Health Study II (NHS II), sub­se­quent di­a­betes risk after a his­to­ry of GDM was significant­ly lower in women who fol­lowed healthy eat­ing pat­terns (83). Ad­just­ing for BMI mod­er­ate­ly, but not com­plete­ly, at­ten­u­at­ed this as­so­ci­a­tion. Interpreg­nan­cy or post­par­tum weight gain is as­so­ci­at­ed with in­creased risk of ad­verse preg­nan­cy out­comes in sub­se­quent preg­nan­cies (84) and ear­li­er pro­gres­sion to type 2 di­a­betes.

Both met­formin and in­ten­sive lifestyle in­ter­ven­tion pre­vent or delay pro­gres­sion to di­a­betes in women with predi­a­betes and a his­to­ry of GDM. Of women with a his­to­ry of GDM and predi­a­betes, only 5–6 women need to be treat­ed with ei­ther in­ter­ven­tion to pre­vent one case of di­a­betes over 3 years (85). In these women, lifestyle in­ter­ven­tion and met­formin re­duced pro­gres­sion to di­a­betes by 35% and 40%, re­spec­tive­ly, over 10 years com­pared with place­bo (86). If the preg­nan­cy has mo­ti­vat­ed the adop­tion of a health­i­er diet, build­ing on these gains to sup­port weight loss is rec­om­mend­ed in the post­par­tum pe­ri­od.