Factors associated with postpartum abnormal glucose tolerance in women diagnosed with gestational diabetes mellitus before 24 weeks of gestation.

Women diagnosed with gestational diabetes mellitus (GDM) before 24 weeks of gestation may have an increased postpartum risk of abnormal glucose tolerance (AGT); however, factors associated with this outcome are unclear. This study aimed to identify factors associated with AGT at 6-12 weeks postpartum in women diagnosed with GDM before 24 weeks of gestation. This single-center retrospective study analyzed patients diagnosed with GDM before 24 weeks of gestation. Postpartum 75-g oral glucose tolerance test (OGTT) results classified participants as AGT (borderline or diabetic) or normal glucose tolerance (NGT). Factors associated with postpartum AGT were examined using multivariate logistic regression analysis. A total of 164 women with GDM were included in this analysis. Postpartum AGT developed in 68 (41.5%) women. A family history of diabetes (aOR, 2.06; 95% CI, 1.12-3.78) and elevated 1 h plasma glucose at diagnosis (per 10 mg/dL increase: aOR 1.16; 95% CI, 1.04-1.28) were independently associated with postpartum AGT, whereas multiparity was protective (aOR, 0.42; 95% CI, 0.23-0.77). In the selection bias analysis, women who completed the postpartum OGTT more frequently received insulin therapy, while total daily insulin dose and most baseline characteristics were comparable. In women diagnosed with GDM before 24 weeks, a family history of diabetes, and higher postload glucose levels were associated with postpartum AGT, whereas multiparity was associated with a lower risk. Although a postpartum OGTT is recommended for all women with GDM, a combined risk assessment may help prioritize postpartum glucose tolerance surveillance. The online version contains supplementary material available at 10.1007/s13340-026-00918-1.