Gestational diabetes mellitus and risk of type 2 diabetes 4 years after the index pregnancy in Moroccan women—A prospective cohort study

Background
The epidemic of diabetes mellitus is spreading throughout the world. Gestational diabetes mellitus (GDM), a transitory form of diabetes first recognized during pregnancy, is a known harbinger of future type 2 diabetes mellitus (T2DM), hypertension, and cardiac disease. To prevent the future onset of T2DM in mothers and offspring, preventive postpartum care and follow-up are necessary. However, the area remains grossly underprioritized. This study aims to examine long-term metabolic changes, including T2DM, in a cohort of Moroccan women with a known history of GDM.

Methods
A prospective cohort study was conducted in the Marrakech-Safi region in Morocco. Women with GDM (initial cohort, n=210) and those who did not develop hyperglycemia (non-GDM) during 2016–2017 were examined in 2020-2021. Women were classified by a 2-h, 75-g oral glucose tolerance test according to the World Health Organization criteria. Historical data from the index pregnancy and anthropometrical measurements were collected.

Results
The median duration of follow-up was 4.00 years. Although our study population was relatively young (mean age 31.1 years), a woman with GDM in the index pregnancy was 3.15 (adjusted OR 3.15; 95% CI 1.25-7.52) times more likely to develop T2DM within 4 years than women with no GDM after controlling for other confounding variables. Women with obesity (BMI ≥ 30 kg/m2) were 4.27 times more likely to develop T2DM than women with normal weight (adjusted OR 4.27; 95% CI 1.32 -13.72). Complying with the recommended healthy diet was a protective factor, markedly decreasing the risk of developing diabetes within four years (OR 0.38; 95% CI 0.16-0.89). GDM and obesity were significant predictors of the development of T2DM.

Conclusion
Given the emerging burden of GDM and the steady increase in diabetes-related morbidity and mortality rates, there is a pressing need to transform the current maternal and child health system to address a burgeoning metabolic challenge for this high-risk population in Morocco. Initiating interventions during preconception and continuing into the postpartum period has the potential to confer long-term maternal-child benefits, promoting virtuous cycles of health.