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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\u00a0years of follow-up (n\u00a0=\u00a034\u2009171). 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.<\/jats:p>","DOI":"10.1093\/aje\/kwae219","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T02:18:33Z","timestamp":1721182713000},"page":"397-406","source":"Crossref","is-referenced-by-count":1,"title":["Prospective transitions in hemoglobin A1c following gestational diabetes using multistate Markov models"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3257-5664","authenticated-orcid":false,"given":"Katharine J","family":"McCarthy","sequence":"first","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York City , NY,","place":["United States"]},{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai , New York City , 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