Postpartum Triglyceride Abnormalities in Women with Recent Gestational Diabetes

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Postpartum Triglyceride Abnormalities in Women
with Recent Gestational Diabetes

• Leona Dang-Kilduff, RN, MSN,CDE
• Mid-Coastal California Diabetes and Pregnancy
  Regional Coordinator
• Stanford University

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Why?

• Women with Gestational Diabetes (GDM) are a high
  risk group for potential Type 2 Diabetes
• We expect GDM women to convert to Type 2 Diabetes
  at 30 by 5 yrs, and 50 by 10 yrs
  Kim 2002
• Once a woman has IGT the conversion rate is as
  high as 17 per year Rattner, DPP

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Why?

• Lipid Abnormalities and Metabolic Syndrome
  characteristics are associated with the
  Development of Type 2 Diabetes Pallardo 2003,
  1999
• Type 2 Diabetes, Lipid Abnormalities and
  Metabolic Syndrome are all associated increasing
  cardiovascular risk
• AND
• If a womans risk are known, she can be counseled
  in preventive activities and monitored

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Methods

• Retrospective chart review from 2001-2003, from 2
  clinics
• Of all women with a history of GDM that presented
  for postpartum glucose screen
• At 6-12 weeks postpartum
• With no history of pre-existing lipid
  abnormalities
• N459 women
• A fasting triglyceride drawn with the postpartum
  75 Gram Oral Glucose Tolerance Test
• Triglycerides gt 150 mg/dl were categorized as
  elevated

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Results by Glucose ScreenThe expected
prevalence of abnormal triglycerides is 17.9 to
23.1 in the general population Ford 2004
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Results By Ethnicity
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Results By Ethnicity
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Results By Ethnicity
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Results By Ethnicity
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Results By Ethnicity
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Summary

• Fasting Abnormalities and Type 2 Diabetes have
  the strongest association with abnormal
  triglycerides
• The expected prevalence of abnormal triglycerides
  is 17.9 to 23.1 in the general population Ford
  2004
• Even the women with normal glucose tolerance had
  a higher then expected incidence of abnormal
  triglycerides

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Summary

• All ethnicities demonstrated abnormal incidence
  of triglycerides
• The Caucasian populations overall abnormal
  triglycrides were less then the expected
  prevalence in the general population
• All other ethnicities (Hispanic, Far East Asian,
  South East Asian and East Indian) all had a
  prevalence rate well above expected in the
  general population
• In all ethnic groups the abnormal triglycerides
  were significantly elevated with any abnormal
  glucose tolerance

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Future Research?

• Examine other ethnic groups
• Examine the effect of birth control Kjos
• Examine the effect of breastfeeding vs bottle
• Larger study. Many of our numbers are small
• Long-term follow up for effect of interventions
• Long-term follow up for effect of DM development,
  lipid abnormalities, metabolic syndrome and
  cardiovascular risk
• Etc

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Now?

• The California Diabetes and Pregnancy
• Program Guidelines for Care, 2009 will
  include the recommendation for women with a
  history of GDM to receive a Lipid screening at 1
  year
• AND
• Postpartum nutrition counseling recommendations
  are now addressing potential lipid abnormalities
• AND
• Also Postpartum recommendations are weight loss
  and exercise

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Contact InformationLeona Dang-Kilduff, RN,
MSN, CDEleonad_at_stanford.edu650-498-5347