Glucose Challenge Test Values Within the Normal Range and Long‐Term Risk of Type 2 Diabetes by Pre‐Pregnancy BMI : A Retrospective Cohort Study

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Abstract
Aims: Gestational diabetes (GDM) is the strongest known risk factor for maternal type 2 diabetes. However, little is known about type 2 diabetes risk in women with normal glucose challenge test (GCT) results during pregnancy. We investigated the association between GCT results in the normal range and type 2 diabetes risk, both overall and across pre‐pregnancy BMI categories. Materials and Methods: This retrospective cohort study identified pregnant women aged 20–50 who had normal (< 140 mg/dL) GCT results between 2004 and 2022. Follow‐up for type 2 diabetes extended from the date of the last documented GCT until 31 September 2024. Survival analyses examine GCT and combine BMI‐GCT exposures. Results: Among 249 190 eligible women (mean age 32.7 years), 1354 developed type 2 diabetes during a median follow‐up of 7 years. GCT results within the normal range were associated with the risk of type 2 diabetes, in a graded manner, without a clear threshold. Compared to women with normal pre‐pregnancy BMI and GCT of 70–89 mg/dL, women with a GCT of 130–140 mg/dL had adjusted hazard ratios for type 2 diabetes ranging from 14.7 (95% CI: 6.2–33.3) among women with normal BMI to 145 (95% CI: 67.7–309) among women with obesity. Conclusions: Pre‐pregnancy BMI and GCT values within the normal range can be used for further type 2 diabetes risk stratification, ranging from minimal risk among women with a GCT < 90 mg/dL and normal weight to substantially increased risk among women with pre‐pregnancy overweight or obesity.

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