{"doi":"10.1093/aje/kwae219","title":"Prospective transitions in hemoglobin A1c following gestational diabetes using multistate Markov models","abstract":"We characterized the state-to-state transitions in postpartum hemoglobin A1c levels after gestational diabetes, including remaining in a state of normoglycemia or transitions between prediabetes or diabetes states of varying severity. We used data from the APPLE Cohort, a postpartum population-based cohort of individuals with gestational diabetes between 2009 and 2011, and linked A1c data with up to 9 years of follow-up (n = 34 171). We examined maternal sociodemographic and perinatal characteristics as predictors of transitions in A1c progression using Markov multistate models. 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 the same state in the next year. Black individuals were more likely to transition from prediabetes to uncontrolled diabetes (adjusted hazard ratio [aHR] = 2.32; 95% CI, 1.21-4.47) than White persons. Perinatal risk factors were associated with disease progression and a 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. We illustrate factors associated with adverse transitions in incremental A1c stages and describe patient profiles that may warrant enhanced postpartum monitoring.","journal":"American Journal of Epidemiology","year":2024,"id":473676,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5069,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":471447,"name":"Shelley H. Liu","orcid":"0000-0003-2171-059X","position":1,"is_corresponding":false},{"id":1041572,"name":"Joseph Kennedy","orcid":"0000-0002-6608-2366","position":2,"is_corresponding":false},{"id":1041573,"name":"Hiu Tai Chan","orcid":"0000-0002-1354-5398","position":3,"is_corresponding":false},{"id":862992,"name":"Victoria Mayer","orcid":"0000-0001-9993-2745","position":4,"is_corresponding":false},{"id":681954,"name":"Luciana Vieira","orcid":"0000-0002-6397-4692","position":5,"is_corresponding":false},{"id":711705,"name":"Kimberly B. Glazer","orcid":"0000-0002-3318-9802","position":6,"is_corresponding":false},{"id":1042250,"name":"Gretchen Van Wye","orcid":null,"position":7,"is_corresponding":false},{"id":658744,"name":"Teresa Janević","orcid":"0000-0002-9934-4406","position":8,"is_corresponding":false},{"id":1041571,"name":"Katharine McCarthy","orcid":"0000-0002-3257-5664","position":0,"is_corresponding":true}],"reference_count":60,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:06:04.967429Z","pmid":"39013791","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}