But “the good news is this red flag” also “provides the opportunity for diabetes prevention.”

A study conducted at Mount Sinai and published in the journal Diabetes Care on June 21 reveals that individuals who develop diabetes after pregnancy face difficulties in controlling the disease, particularly if they had gestational diabetes during their pregnancy. This challenge is especially prominent among Black or Hispanic women.

The study also indicates that those who experience gestational diabetes are over 11 times more likely to develop diabetes within nine years following delivery compared to those without such a history.

The research, led by scholars from the Icahn School of Medicine at Mount Sinai, identifies the period between 12 weeks and one year after childbirth as the phase with the highest occurrence of diabetes and the lowest chances of diabetes control.

The findings suggest that regular diabetes screenings, particularly during the early postpartum period, can significantly impact the speed and trajectory of disease progression in the future.

Both gestational diabetes and type 2 diabetes (adult-onset diabetes) are major risk factors for cardiovascular disease. These conditions are also associated with persistent racial and ethnic disparities, often arising from inequities in healthcare access and treatment.

While previous studies have focused on how gestational diabetes influences the development of type 2 diabetes later in life, fewer investigations have examined how gestational diabetes affects disease severity or control after a diabetes diagnosis.

The Mount Sinai researchers delved into the interactions between race, ethnicity, and gestational diabetes, aiming to understand their combined influence on diabetes risk and glycemic control (i.e., achieving recommended blood sugar levels).

The study found that individuals of South and Southeast Asian descent had the highest incidence of gestational diabetes, although their risk for diabetes after delivery was somewhat lower compared to other racial and ethnic groups, albeit still significantly high. Among those who developed diabetes after delivery, a history of gestational diabetes was associated with greater difficulty in controlling glucose levels.

Notably, Black and Hispanic individuals with postpartum-onset diabetes following gestational diabetes experienced a longer time to achieve control of their glucose levels compared to those without gestational diabetes.

The corresponding author of the study, Katharine McCarthy, PhD, MPH, Assistant Professor of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science at Icahn Mount Sinai, emphasized “the importance of regular diabetes screening following gestational diabetes, particularly in the first 12 months following delivery—which was marked by the highest incidence of diabetes and least likelihood of glycemic control—in order to facilitate early detection and appropriate diabetes management.” She also highlighted the need for “care coordination between obstetric and primary care providers, provider education on the importance of obstetric history-taking is essential in facilitating diabetes awareness and early glycemic control.”

To conduct the research, the team created a unique population-based cohort comprising over 330,000 postpartum women in New York City. They utilized data from 2009 to 2017, including birth records containing information on pregnancy-related comorbidities, such as gestational diabetes and gestational hypertensive disorders, as well as self-reported race, ethnicity, and socio-demographic characteristics like age, nativity, education, and insurance status.

The analysis by Mount Sinai researchers confirmed previous estimates of diabetes risk associated with gestational diabetes and expanded on limited existing evidence regarding racial and ethnic differences in the impact of gestational diabetes.

The findings support policies that facilitate and enhance access to postpartum healthcare, such as extending Medicaid coverage beyond the immediate postpartum period.

The results show “that a history of gestational diabetes is a red flag for higher risk of diabetes but also poorer control down the line, with Black and Hispanic women most affected,” added senior author Teresa Janevic, PhD, MPH, Associate Professor of Obstetrics, Gynecology and Reproductive Science, Population Health Science and Policy, and Global Health and Health Systems Design at Icahn Mount Sinai.

And “the good news is this red flag provides the opportunity for diabetes prevention, if we focus more intently on mom’s health in the first year postpartum.”

In their upcoming research, the Mount Sinai team plans to delve into the impact of the neighborhood environment on long-term diabetes outcomes following gestational diabetes. Their objective is to identify beneficial policies that can effectively reduce the risk of diabetes. The study received contributions from the New York City Department of Health and Mental Hygiene, and it was financially supported by grants (R21DK122266 and R01DK134725) from the National Cancer Institute at the National Institutes of Health.

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