Prädiktoren in der Indexgravidität für postpartale metabolische Erkrankungen bei Gestationsdiabetes

Gestational diabetes (GDM) and type 2 diabetes mellitus (Dm2) are together associated diseases characterized by insulin resistance. Dm2 is accompanied by the high cardiovascular risk of morbidity and mortality. Issue: It should be clarified whether in gestational diabetes already during pregnancy there can be found predictive markers which detect the risk of early postpartum metabolic diseases. Patients and Methods: 186 women (age 34 +/- 6 years [20 - 47], BMI 29 +/- 7 kg/m(2) [19 - 50]) were examined both in diagnosis and in the median 1 year from GDM regarding oGTT, insulin resistance, hyperlipoproteinemia, hsCRP, blood pressure. Results: One year after pregnancy with GDM-following disturbances of glucose metabolism could be found: iFG 12 %, iGT 8 %, iFG/iGT 7 %, Dm2 10 %. In pathological oGTT (37 %) vs. Healthy (63 %) the following parameters were higher: HOMA-Index (3.9 +/- 2.8 vs. 2.0 +/- 1.3, p < 0.001), C-peptide (3.6 +/- 3.2 vs. 2.1 +/- 1.2 ng/ml, p < 0.05), HbA1c (6.2 +/- 0.8 vs. 5.8 +/- 0.3 %, p < 0.0001), uric acid (306 +/- 63 vs. 275 +/- 74 mu mol/l, p < 0.01), triglyceride (1.7 +/- 0.9 vs. 1.1 +/- 0.5 mmol/l, p < 0.001), LDL/HDL-Quotient (2.7 +/- 0.9 vs. 2.1 +/- 0.9, p < 0.001), age (36 +/- 5 vs. 33 +/- 6 years, p < 0.01), BMI (32 +/- 7 vs. 27 +/- 6 kg/m(2), p < 0.001), blood pressure: (systolic 123 +/- 18 vs. 116 +/- 14 mmHg, p < 0.01, diastolic 78 +/- 12 vs. 72 +/- 10 mmHg, p < 0.01). Women with pathological oGTT postpartum showed at the time of index pregnancy a higher BMI (30 +/- 7 vs. 26 +/- 6 kg/m(2), p < 0.0001), needed a higher insulin dose per kg BW (0.8 +/- 0.5 vs. 0.5 +/- 0.3 IE, p < 0.0001), had a higher blood pressure: (systolic 126 +/- 16 vs. 118 +/- 13 mmHg, p < 0.01, diastolic 78 +/- 12 vs. 73 +/- 10 mmHg, p < 0.001) und showed higher laboratory parameters: oGTT-glucose (fasting 5.4 +/- 1.2 vs. 4.7 +/- 0.7, p < 0.001; 1 h 10.6 +/- 2.0 vs. 9.7 +/- 1.4, p < 0.001; 2 h 8.6 +/- 2.0 vs. 7.5 +/- 1.8 mmol/l, p < 0.01), HbA1c (6.1 +/- 0.5 vs. 5.7 +/- 0.4 %, p < 0.0001), uric acid (248 +/- 63 vs. 216 +/- 59 mu mol/l, p < 0.01), HOMA (4.7 +/- 3.8 vs. 3.0 +/- 2.1, p < 0.01); C-peptide (3.1 +/- 1.4 vs. 2.5 +/- 1.1 ng/ml, p < 0.01). Prognostically relevant regarding the predictability of a postpartal metabolic disorder there were the insulin dose >= 50 IE/day, the pregravide BMI >= 25 kg/m(2) and blood pressure >= 140/90 mmHg as the predictive markers to detect. Summary: An impaired glucose tolerance shows in the index pregnancy clear metabolic risk markers like metabolic disorder and high normal blood pressure. Women with GDM and increased risk markers require preventive therapies with early diagnosis and conservative treatments.