Prospective transitions in hemoglobin A1c following gestational diabetes using Multistate Markov Models.
Am J Epidemiol
; 2024 Jul 16.
Article
en En
| MEDLINE
| ID: mdl-39013791
ABSTRACT
OBJECTIVE:
We characterized the state-to-state transitions in postpartum A1c levels after gestational diabetes, including remaining in a state of normoglycemia or transitions between prediabetes or diabetes states of varying severity.METHODS:
We used data from the APPLE Cohort, a postpartum population-based cohort of individuals with gestational diabetes between 2009-2011and linked HbA1c data with up to 9 years follow-up (N=34,171). We examined maternal sociodemographic and perinatal characteristics as predictors of transitions in A1c progression using Markov multistate models.RESULTS:
In the first-year postpartum following gestational diabetes, 45.1% of people had no-diabetes, 43.1% had prediabetes, 4.6% had controlled diabetes and 7.2% had uncontrolled diabetes. Roughly two-thirds of individuals remained in same state in the next year. Black individuals were more likely to transition from pre-diabetes to uncontrolled diabetes (aHR 2.32 95% CI 1.21 ,4.47) than White persons. Perinatal risk factors were associated with disease progression and lower likelihood of improvement. For example, hypertensive disorders of pregnancy were associated with a stronger transition (aHR 2.06 95% CI 1.39, 3.05) from prediabetes to uncontrolled diabetes.CONCLUSIONS:
We illustrate factors associated with adverse transitions in incremental A1c stages and describe patient profiles who may warrant enhanced postpartum monitoring.
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MEDLINE
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En
Revista:
Am J Epidemiol
Año:
2024
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Article