Early postpartum dysglycemia after gestational diabetes: β-cell dysfunction and risk stratification in a multiethnic cohort.

Introduction: Postpartum oral glucose tolerance test (OGTT) screening is recommended after gestational diabetes (GDM), but attendance is often incomplete and testing may not capture metabolic heterogeneity. Western-derived risk models may be less applicable to Asians, in whom Methods: We retrospectively studied 575 women with GDM managed at a tertiary center in Singapore between 01/10/2023 to 30/04/2025. Early postpartum Results: Postpartum OGTT completion rate was 71.1% (409/575). Among women tested, 34.2% (140/409) had early postpartum dysglycemia. Dysglycemia occurred in a relatively lean phenotype and was associated with lower homeostatic model assessment of β-cell function (HOMA-β). Independent predictors were family history of diabetes, prior GDM, elevated pregnancy 2-hours OGTT glucose, Chinese ethnicity, and higher HbA1c while Conclusions: Early postpartum dysglycemia after GDM was common and appeared consistent with a relatively lean, β-cell-predominant phenotype. Pragmatic risk stratification may complement tiered postpartum surveillance and prevention.