Association between Glycemic Management during Pregnancy and Postpartum Metabolic Health Outcomes among Women with Gestational Diabetes Mellitus

Background Glycemic management is standard for gestational diabetes mellitus (GDM), yet its impact on postpartum metabolic health, especially in late-onset GDM, remains uncertain. Objective To assess whether achieving glycemic control during pregnancy improves postpartum metabolic health compared to those who do not. Methods From June 2021 to December 2022, 358 gestational diabetes mellitus (GDM) cases and 750 controls were recruited at 24~28 weeks of gestation from Ma'anshan Maternal and Child Health Care Center, China. Participants were categorized into four groups based on third-trimester fasting plasma glucose (FPG): 1) Non-GDM, 2) GDM with normal glycemic control (FPG < 5.1 mmol/L), 3) GDM with abnormal glycemic control, and 4) late-onset GDM. Follow-ups at 42 days and 1 year postpartum included questionnaires, physical examinations, and metabolic measurements. Multivariate regression analyzed associations between glycemic control and postpartum outcomes. Results Among 642 and 736 participants followed at 42 days and 1 year postpartum, GDM with abnormal glycemic control had increased risks of blood glucose ( OR = 5.22, [95% CI 1.66 to 16.38], P =0.005) and TG abnormalities ( OR = 2.43, [95% CI 1.01 to 5.85], P =0.048). No significant associations were found for GDM with normal glycemic control or late-onset GDM. Compared to GDM with normal control, abnormal control increased risks of 2-hour glucose ( OR = 2.77, [95% CI 1.02 to 7.53], P =0.045) and TC abnormalities ( OR = 2.97, [95% CI 1.08 to 8.18], P =0.035). Conclusions Glycemic management during pregnancy improves postpartum metabolic outcomes, highlighting the importance of GDM diagnosis and subsequent glycemic control.