Postpartum screening and contraceptive use in women with gestational diabetes

Objective To evaluate subsequent reproductive choices facing women with pri or gestational diabetes mellitus (GDM) and their impact on the risk of deve loping type 2 diabetes. Research design and methods The utility of postpartum carbohydrate toleranc e testing and the effects of a subsequent pregnancy and of various contrace ptive methods on the development of diabetes in women with prior GDM were a ssessed by a review of the current literature. Results The presence of postpartum impaired glucose tolerance in women with prior GDM identifies a subset of women who a re at substantial risk for di abetes with in 5 years after the index pregnancy. Subsequent pregnancy in w omen with prior GDM appears to triple the risk of subsequent diabetes. Long -term use of low-dose progestin and estrogen combination oral contraceptive s does not appear clinically to increase the risk of diabetes. Conversely, the use of progestin-only oral contraceptives in breast-feeding women with prior GDM appears to almost triple their risk of diabetes. Weight loss afte r pregnancy may substantially decrease the risk of diabetes. Conclusion In women with prior GDM, the presence of postpartum impaired glu cose tolerance, exposure to a repeat pregnancy or the use of progestin-only oral contraceptives during lactation each independently appear to increase the risk of subsequent diabetes. Conversely, the use of low-dose progestin and estrogen combination oral contraceptives does not appear to increase t he risk of diabetes.