Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study
Authors: Napoli Angela , Sciacca Laura , Pintaudi Basilio , Tumminia Andrea , Dalfrà Maria Grazia , Festa Camilla , Formoso Gloria , Fresa Raffaella , Graziano Giusi , Lencioni Cristina , Nicolucci Antonio , Rossi Maria Chiara , Succurro Elena , Sculli Maria Angela , Scavini Marina , Vitacolonna Ester , Bonomo Matteo , Torlone Elisabetta ,   the STRONG Study Collaborators and the AMD-SID Diabetes and Pregnancy Study Group, Napoli Angela , Bitterman Olimpia , Festa Camilla , Giuliani Chiara , Bonomo Matteo , Pintaudi Basilio , Cimino Elena , Mion Elena , Marcone Teresa , Lencioni Cristina , Di Cianni Graziano , Sciacca Laura , Tumminia Andrea , Milluzzo Agostino , Vitacolonna Ester , Fraticelli Federica , Franzago Marica , Dodesini Alessandro Roberto , Ciriello Elena , Dalfrà Mariagrazia , Lapolla Annunziata , Fresa Raffaella , Grassi Aurora , Limone Paolo , Nuzzi Annamaria , Masha Andi , Grimaldi Laura , Biglino Sara , Ansaldi Egle , Battezzati Maurizia , Meregalli Giancarla , De Mori Valentina , Berzi Denise , Bossi Antonio , Baggi Viviana , Lovati Elisabetta , Quarleri Lara , Romanelli Tiziana , Clementi Silvia , Nicolao Ilaria , Zambotti Francesca , Lombardi Simonetta , Costa Silvana , Tommasi Chiara , Rancan Silvia , Lisato Giovanna , Bordon Paola , Turazzi Daniela , Mollo Francesco , Grimaldi Franco , Tonutti Laura , Agus Sandra , Falivene Maria Rosaria , Versari Giorgio , Corsi Laura , Delucchi Maria , Ratto Luisa , Magotti Maria Grazia , Frusca Tiziana , Haddoub Silvia , Suprani Alice , Mori Mary , Vita Maria Grazia , Di Biase Nicolina , Bertolotto Alessandra , Aragona Michele , Bianchi Cristina , Lacaria Emilia , Guarino Elisa , Monaci Federica , Dotta Francesco , Torlone Elisabetta , Lalli Carlo , Di Loreto Chiara , Scarponi Maura , Del Prete Angela , Leotta Sergio , Coletta Iolanda , Abbruzzese Santina , Montani Valeria , Cannarsa Emanuela , Contini Pierpaolo , Vero Raffaella , Oliverio Rosa , Scavini Marina , Dozio Nicoletta , Imbergamo Maria Pia , Cordera Renzo , Affinito Laura , Maggi Davide , Bordone Caterina , Fochesato Elena , Pissarelli Alessandra , Libera Eros , Morano Susanna , Filardi Tiziana , Fallarino Mara 
Published: April 2021

Abstract
Aims
To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD).

Methods
Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk.

Results
From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI <  = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk.

Conclusions
Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.