Abnormalities persist postpartum in gravidas with lesser degrees of hyperglycemia

OBJECTIVE: Recently it lias been shown that gravidas having lesser degrees of hyperglycémie (GDM bv lower threshold criteria of Coustan, Sacks, 1-abnormal GTT value), identify morbidity at an incidence and efficiency comparable to current AGOG standards. 60% of these gravidas also evidence both insulin secretion and sensitivity (S,) below normal during pregnancy. The hypothesis of this study is that these patients would continue to have increased insulin resistance and decreased insulin response postpartum (PP), METHODS: 14 patients with lesser degrees of hvperglvcemia during pregnamv were investigated PP using the insulin-modified, Minimal Model (Bergman) to measure glucose, S,. and 1st phase insulin {0-19 miii). '_>() normal, non-pregnant women matched tor age and obesity were studied as controls. RESULTS: The lesser degree subjects were compared to the ine;m normal curve (see figure). 71% of the sludv women had both S, and insulin response below ihe normal curve, i.e. values in the lower left corner of (he graph. Additionally: (1) 8f)f/c of low responders in pregnancy remained abnormal PP; (2) 20% reverted to normal; (3) All gravidas abo\e the non-GDM curve during pregnancy remained above normal PP. CONCLUSION: The decreased sensitivity and insulin secretion that persists PP in gravidas with lesser degrees of hvperghcemia, form ihe basis of their abnormal glycémie profile and adverse perinatal outcome, and strongly support their being considered at increased risk for future GDM and Type II diabetes.