Prospective transitions in hemoglobin A1c following gestational diabetes using Multistate Markov Models.

Autor:	McCarthy KJ; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, US.; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, USA., Liu SH; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, US., Kennedy J; Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, USA., Chan HT; Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, USA., Mayer VL; Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA., Vieira L; Department of Maternal and Fetal Medicine, Stamford Hospital, Stamford, CT, USA., Glazer KB; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, US.; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, USA., Van Wye G; Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York City, USA., Janevic T; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, USA.
Jazyk:	angličtina
Zdroj:	American journal of epidemiology [Am J Epidemiol] 2024 Jul 16. Date of Electronic Publication: 2024 Jul 16.
DOI:	10.1093/aje/kwae219
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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