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Early postpartum dysglycemia after gestational diabetes: β-cell dysfunction and risk stratification in a multiethnic cohort
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DOI：10.3389/fendo.2026.1913417.png)
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Abstract
En 中文
IntroductionPostpartum oral glucose tolerance test (OGTT) screening is recommended after gestational diabetes (GDM); but attendance is often incomplete and testing may not capture metabolic heterogeneity. Western-derived risk models may be less applicable to Asians; in whom dysglycemia may occur at lower body mass index (BMI) and reflect greater β-cell vulnerability. We examined the prevalence; clinical phenotype and predictors of early postpartum dysglycemia in women with GDM.MethodsWe retrospectively studied 575 women with GDM managed at a tertiary center in Singapore between 01/10/2023 to 30/04/2025. Early postpartum dysglycemia was defined by World Health Organization criteria using 6–8 weeks postpartum OGTT. Multivariate logistic regression identified predictors of postpartum dysglycemia. Missing data were handled by multiple imputation; candidate predictors were screened by univariate logistic regression and assessed for multicollinearity using variance inflation factors. Model performance was evaluated by area under the receiver operating characteristics curve (AUC); with internal validation using 1000 bootstrap resamples. Dominance analysis quantified relative predictor contributions.ResultsPostpartum OGTT completion rate was 71.1% (409/575). Among women tested; 34.2% (140/409) had early postpartum dysglycemia. Dysglycemia occurred in a relatively lean phenotype and was associated with lower homeostatic model assessment of β-cell function (HOMA-β). Independent predictors were family history of diabetes; prior GDM; elevated pregnancy 2-hours OGTT glucose; Chinese ethnicity; and higher HbA1c while in-vitro fertilization and higher pre-pregnancy BMI were inversely associated with dysglycemia. Discrimination was good with AUC 0.77 (95% CI 0.72 – 0.81). Dominance analysis ranked pregnancy 2-hour OGTT glucose (18.8%) and family history (17.1%) as top contributors. Threshold analyses suggested pregnancy 2-hours OGTT ≥8.5 mmol/L was specific but insensitive; whereas antepartum HbA1c ≥5.5% was sensitive but less specific.ConclusionsEarly postpartum dysglycemia after GDM was common and appeared consistent with a relatively lean; β-cell–predominant phenotype. Pragmatic risk stratification may complement tiered postpartum surveillance and prevention.
Keywords:
gestational diabetes
body mass index
oral glucose tolerance test
Asian phenotype
postpartum dysglycemia
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