Gestational Diabetes and the Incidence of Type 2 Diabetes
Open accessAbstract
OBJECTIVE—To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS—We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes. RESULTS—A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. CONCLUSIONS—Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required.
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Risk factors for the progression to type 2 diabetes mellitus include maternal age, family history of diabetes, glycemic indices during pregnancy, and genetic predisposition, which are not modifiable after delivery.
“The risk factors for the progression to type 2 diabetes mellitus include maternal age, family history of diabetes, glycemic indices during pregnancy, and genetic predisposition, which are not modifiable after delivery [10,46].”
From Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications (2022) · cites this paper as [10]
In “Other risk factors for type 2 diabetes” (page not provided), the review identifies elevated fasting glucose during pregnancy as a predictor of later diabetes. It reports that maternal age and family history were generally not associated with progression, contrary to their inclusion as established risk factors. The passages do not establish genetic predisposition as a predictor or characterize the listed factors collectively as unmodifiable after delivery. (LLM, conf=0.90)
Experimental — accuracy not yet measuredGDM is often indicative of underlying β-cell dysfunction, which confers marked increased risk for later development of diabetes, generally but not always type 2 diabetes, in the mother after delivery.
“GDM is often indicative of underlying b -cell dysfunction (200), which confers marked increased risk for later development of diabetes, generally but not always type 2 diabetes, in the mother after delivery (201,202).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [202]
The introduction and Conclusions (page numbers unavailable in our copy) identify GDM as a risk factor for maternal type 2 diabetes and report that progression rises steeply in the first five years after delivery. The paper examines type 2 diabetes, but does not establish the claim’s qualification that later diabetes is sometimes another type. The β-cell dysfunction clause is attached to a different citation in the citing sentence. (LLM, conf=0.85)
Experimental — accuracy not yet measuredGDM is often indicative of underlying beta-cell dysfunction, which confers marked increased risk for later development of glucose intolerance and diabetes in the mother after delivery.
“GDM is often indicative of underlying b-cell dysfunction (182), which confers marked increased risk for later development of glucose intolerance and diabetes in the mother after delivery (183-185).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [184]
Women with GDM are at high risk for developing type 2 diabetes in subsequent years.
“It has been well documented and generally accepted that women found to have GDM are at high risk for development of type 2 diabetes mellitus (T2DM) in subsequent years.1,8,9”
From Gestational Diabetes Mellitus (2019) · cites this paper as [8]
Women with gestational diabetes are at considerably increased risk of developing diabetes later in life.
“because women with GDM are at a considerably increased risk of developing diabetes later (179)”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [179]
Women with gestational diabetes have been suggested to have a 20%-60% risk of developing diabetes 5 to 10 years after pregnancy.
“For comparison, women with gestational diabetes have been suggested to have a 20%–60% risk of developing diabetes 5 to 10 years after pregnancy.20–22”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [20]
Seventy percent of women who are diabetic during pregnancy develop type 2 diabetes later in life.
“Interestingly, long-term follow-up studies show that 70% of women who are diabetic during pregnancy develop type 2 diabetes later in life, emphasizing that the ability of β-cells to successfully adapt to increases in metabolic load is a common theme for preventing both gestational diabetes and type 2 diabetes [42].”
From Expansion of β-cell mass in response to pregnancy (2010) · cites this paper as [42]
The capacity of β-cells to adapt successfully to increased metabolic load is a shared requirement for preventing both gestational diabetes and type 2 diabetes.
“Interestingly, long-term follow-up studies show that 70% of women who are diabetic during pregnancy develop type 2 diabetes later in life, emphasizing that the ability of β-cells to successfully adapt to increases in metabolic load is a common theme for preventing both gestational diabetes and type 2 diabetes [42].”
From Expansion of β-cell mass in response to pregnancy (2010) · cites this paper as [42]
When compensatory β-cell mass expansion fails during gestation, diabetes results.
“However, as with obese individuals, when compensatory β-cell mass expansion fails during gestation, diabetes results.”
From Expansion of β-cell mass in response to pregnancy (2010) · cites this paper as [42]
Women with a history of gestational diabetes mellitus have a greatly increased subsequent risk for diabetes.
“Because women with a history of GDM have a greatly increased subsequent risk for diabetes (25), they should be screened for diabetes 6–12 weeks postpartum, using nonpregnant OGTT criteria, and should be followed up with subsequent screening for the development of diabetes or pre-diabetes, as outlined in Section II.”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [25]
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“GDM places both the mother and baby at risk of pregnancy complications, such as pre-eclampsia, macrosomia, neonatal hypoglycaemia and respiratory distress (13), and further increases risk to mother and baby of developing type 2 diabetes later in life (14, 15).”
Background
- Authors
- Kim, C., Newton, K. M., & Knopp, R. H.
- Affiliations
- University of Michigan (US)
- Group Health Cooperative (US)
- University of Washington (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2002-10-01
- Volume
- 25
- Issue
- 10
- Pages
- 1862-1868
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2021441410
- Cited by
- 2,276
- References
- 58
- Citations by year
- 2026: 63 · 2025: 75 · 2024: 95 · 2023: 75 · 2022: 116 · 2021: 120 · 2020: 133 · 2019: 126 · 2018: 140 · 2017: 205 · 2016: 137 · 2015: 139 · 2014: 133 · 2013: 101 · 2012: 110
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, type 2 diabetes, cumulative incidence, risk factors, fasting blood glucose, ethnic differences, racial disparities, follow-up duration, cohort retention
- MeSH terms
- Diabetes Mellitus, Type 2, Ethnicity, Female, Humans, Pregnancy, Time Factors, Incidence, Diabetes, Gestational, Delivery, Obstetric, PubMed
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