11 Long-term implications of gestational diabetes for the mother

Henry, Olivia A.; Beischer, Norman A.

doi:10.1016/s0950-3552(05)80107-5

Cited by 108 publications

(86 citation statements)

References 40 publications

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“…HDP is associated with gestational diabetes, 43 and gestational diabetes is a risk factor for future development of diabetes. 44 We have no information on history of gestational diabetes in the ECAC Study; thus, we cannot determine if this attenuation of effect is due to HDP additionally capturing some women with gestational diabetes. Future studies are needed to assess the individual and joint effects of HDP and gestational diabetes on future development of subclinical coronary artery atherosclerosis.…”

Section: Discussionmentioning

confidence: 98%

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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Background: Hypertension during pregnancy (HDP) increases the risk of future coronary heart disease (CHD), but it is unknown whether this association is mediated by renal injury. Reduced renal function is both a complication of HDP and a risk factor for CHD. Methods: Logistic regression models were fit to examine the association between a history of HDP and the presence and extent of coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, in 498 women from the Epidemiology of Coronary Artery Calcification Study (mean age 63.3 AE 9.3 years). Results: Fifty-two (10.4%) women reported a history of HDP. After adjusting for age at time of study participation, HDP was associated with increased serum creatinine later in life ( p ¼ 0.014). HDP was positively associated with the presence of CAC after adjusting for age at time of study participation (OR ¼ 2.7, 95% CI 1.4-5.4). This association was slightly attenuated with adjustment for body size and blood pressure (OR ¼ 2.4, 95% CI 1.2-4.9) but was not further attenuated with adjustment for serum creatinine and urinary albumin=creatinine ratio (OR ¼ 2.6, 95% CI 1.3-5.3). Results were similar for CAC extent. Conclusions: HDP may increase a woman's risk of future CHD beyond traditional risk factors and renal function. Women with a history of HDP should be monitored for potential increased risk of CHD as they age.

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Section: Discussionmentioning

confidence: 98%

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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“…was not a result of the regression analysis [6]. It was added to the risk-chart because these patients have a high risk of developing Type 2 diabetes later in life [18] down in the risk-chart (translated from Danish to English) and the parameterisation. The numerical score associated with the answer to each of the questions could be summarised to an overall risk-score between 0 and 14 points after completion of the questionnaire.…”

Section: Methodsmentioning

confidence: 99%

Population-based stepwise screening for unrecognised Type�2 diabetes is ineffective in general practice despite reliable algorithms

Christensen

Sandbæk²,

Lauritzen

et al. 2004

Diabetologia

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Aims/hypothesis. The yield of screening programmes for Type 2 diabetes in the existing healthcare setting might be lower than anticipated from tests of screening algorithms in data from epidemiological surveys. Our aims were to evaluate the reliability of the algorithms and the effectiveness of a proposed stepwise screening programme for Type 2 diabetes in general practice. Methods. The screening programme had four steps: (i) mail-distributed self-administered risk-chart; (ii) screening tests: random blood glucose (RBG) and HbA 1 c; (iii) diagnostic procedure 1 for fasting blood glucose (FBG) (if RBG ≥5.5 mmol/l or HbA 1 c ≥6.1%); and (iv) OGTT as diagnostic procedure 2 (if 5.6≤FBG<6.1 mmol/l or HbA 1 c ≥6.1%). Abnormalities of glucose metabolism were classified according to the WHO 1999 criteria, based on capillary whole blood. The subjects were all patients between 40 and 69 years of age (n=60,926) who were registered in 88 general practices and had not been previously diagnosed with diabetes.Results. A total of 11,263 individuals had a high-risk risk-score and attended the screening consultation (step 1 test-positive). Of these, 30.1% needed diagnostic tests (step 2 test-positive) and 27.2% of these needed an OGTT (step 3 test-positive). The test-positive proportions were equal to the proportions obtained in data from a population-based survey from Step 2 onwards, and the algorithms were thus reliable. The identification rate was only 19% of all prevalent undiagnosed diabetes according to a recently published prevalence estimate. This was due to a large dropout rate among high-risk individuals prior to entry into the programme. Conclusions/interpretation. Population-based maildistributed stepwise screening for Type 2 diabetes in general practice is ineffective, despite reliable screening algorithms, primarily because many high-risk individuals fail to participate.

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“…It leads to changes in pancreatic development and peripheral response to insulin which may cause gestational diabetes mellitus (GDM) and adult onset Type 2 diabetes. GDM increases the lifetime risk of developing diabetes, at over 3 times compared to controls at 16 years after index pregnancy [14]. By 17 years of age one-third of children born of gestational diabetic mothers have had evidence of IGT or Type 2 diabetes [15].…”

Section: Risk Factorsmentioning

confidence: 99%

Diabetes Mellitus in India: The Modern Scourge

Mehta¹,

Kashyap

Das³

2009

Medical Journal Armed Forces India

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India has a high prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. In India alone, diabetes is expected to increase from 40.6 million in 2006 to 79.4 million by 2030. Studies have shown that the prevalence of diabetes in urban Indian adults is about 12.1%, the onset of which is about a decade earlier than their western counterparts and the prevalence of Type 2 diabetes is 4-6 times higher in urban than in rural areas. The risk factors peculiar for developing diabetes among Indians include high familial aggregation, central obesity, insulin resistance and life style changes due to urbanization. Screening for gestational diabetes and impaired glucose tolerance among pregnant women provides a scope for primary prevention of the disease in mothers as well as in their children. The problems of obesity and impaired glucose tolerance (IGT) (important predisposing factors) are not confined to adults alone but children are also increasingly getting affected. Most long standing macro and micro vascular complications are also more common among Indian diabetics as compared to other races and ethnic groups. A strong familial clustering of diabetic nephropathy among Indian Type 2 diabetics has also been noted. Clustering of cardiovascular risk factor like Syndrome X is common among urban Indians. The rising incidence of diabetes and its complications are going to pose a grave health care burden on our country. Timely effective interventions/measures and screening tests for complications at the time of diagnosis becomes imperative not only for early detection, but also to prevent progression to end stage disease. Screening for gestational diabetes among pregnant women would also go a long way in primary prevention of the disease. Life style changes/interventions and drugs like rosiglitazone are the current strategies that can prevent and/or delay the onset of diabetes. Simple interventional strategies like "Eat less, Eat on time and Walk more" can go a long way in preventing these chronic disorders among present as well as in the future generations. MJAFI 2009; 65 : 50-54

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11 Long-term implications of gestational diabetes for the mother

Cited by 108 publications

References 40 publications

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Population-based stepwise screening for unrecognised Type�2 diabetes is ineffective in general practice despite reliable algorithms

Diabetes Mellitus in India: The Modern Scourge

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