Cardiometabolic Consequences of Gestational Dysglycemia

Brewster, Shireen; Zinman, Bernard; Retnakaran, Ravi; Floras, John S.

doi:10.1016/j.jacc.2013.01.080

Cited by 43 publications

(29 citation statements)

References 67 publications

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“…In this study, we observed a significant association between GDM and CVD among both obese and non-obese women, although the association seemed stronger among obese women compared to non-obese women. Previous studies have shown that altered lipid metabolism, impaired endothelial function, and vascular inflammation may be implicated in the pathogenesis of CVD after GDM (31, 32). Our results indicate that low levels of HDL cholesterol may contribute to the increased risk of CVD in women with prior GDM.…”

Section: Discussionmentioning

confidence: 99%

History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women

et al. 2017

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BackgroundFindings from previous studies examining the association between gestational diabetes mellitus (GDM) and subsequent risk of cardiovascular disease (CVD) have been inconsistent and inconclusive. We aimed to examine the associations of a previous history of GDM with risk of CVD and status of cardiovascular risk factors in a nationwide population-based study in the United States.MethodsThis study included 8,127 parous women aged 20 years or older in the 2007–2014 cycles of the National Health and Nutrition Examination Survey in the United States. The exposure was self-reported diagnostic history of GDM and the outcomes were self-reported diagnostic history of CVD and measurements of cardiovascular risk factors, including blood pressure and blood lipids. Regression models with sample weights were used to examine the associations of GDM with CVD and cardiovascular risk factors.ResultsAmong women with a history of both GDM and CVD, CVD was diagnosed on average 22.9 years after the diagnosis of GDM. After adjustment for demographic, socioeconomic, and lifestyle factors, a history of GDM was associated with 63% higher odds of CVD [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.02, 2.62, p-value = 0.04]. Further adjustment for body mass index (BMI) modestly attenuated the association (OR 1.52, 95% CI 0.95, 2.44, p-value = 0.08). A history of GDM was significantly associated with lower serum level of HDL-cholesterol (adjusted β-coefficient −3.33, 95% CI −5.17, −1.50, p-value ≤ 0.001), but not associated with total cholesterol, LDL-cholesterol, triglycerides, or systolic or diastolic blood pressure. Similarly, the association between a history of GDM and HDL cholesterol was attenuated after additional adjustment for BMI (adjusted β-coefficient −1.68, 95% CI −3.38, 0.03, p-value = 0.54).ConclusionWomen with a previous history of GDM have significantly higher risk for developing CVD and lower serum level of HDL cholesterol, compared to women without a history of GDM. The associations may be explained, at least partly, by BMI.

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Section: Discussionmentioning

confidence: 99%

History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women

et al. 2017

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“…Specifically, among non-Koreans, women with histories of GDM had greater vascular resistance, lower stroke volume, lower cardiac output [83]. Small cross-sectional studies conflict as to whether flow mediated dilation is impaired among women with histories of GDM [84]. Among Italian women, women with GDM had higher carotid intimal medial thickness at approximately 6.5 years postpartum compared to women without histories of GDM [85], even after adjustment for other cardiovascular disease (CVD) risk factors.…”

Section: Postpartum Maternal Outcomesmentioning

confidence: 99%

Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups

Kim

2014

Diabetes Metab J

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Gestational diabetes mellitus (GDM) reflects defects in insulin secretion in response to the metabolic demands of pregnancy. While GDM is increasingly common worldwide due in large part to the obesity epidemic, its frequency is relatively low in Korean women. In this report, the prevalence and risk factors for GDM, perinatal outcomes, and postpartum course are compared in non-Korean and Korean women. While Koreans and non-Koreans with GDM share pathophysiology and complications, there may be differences in the role of obesity and thus the effectiveness of interventions targeting obesity in GDM women. Further investigations of the effectiveness of weight loss interventions and pharmacotherapy specifically among Korean women are needed. Dietary and other lifestyle data from Korean populations could inform prevention and treatment strategies in other countries which suffer from significantly higher prevalences of GDM.

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“…44 Recent data showed that in addition to gestational diabetes mellitus, even mild forms of dysglycemia during pregnancy represent a maternal phenotype of increased subsequent cardiometabolic risk. 45 Our data revealed that the MetS participants underwent a progressive worsening of glucose metabolism from enrollment at gestational age of 11 +0 to 13 +6 weeks, to at term, and to ≈1.6 years postpartum. This finding is consistent with a recent report that β-cell function declines within the first year postpartum.…”

Section: Lei Et Al Prehypertension and Postpartum Metabolic Syndrome 461mentioning

confidence: 63%

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors

Lei

Zhou

et al. 2016

Hypertension

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A s a result of biphasic changes in peripheral arterial resistance during pregnancy, the blood pressure (BP) level undergoes a gradual decrease to the nadir at midpregnancy and returns to a prepregnant level through term.1,2 Consequently, this physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the nonpregnant population. The optimal BP levels in pregnant women remain an open question.Emerging evidence shows that prehypertension (120-139/80-89 mm Hg), defined by the seventh report of the Joint National Committee on Prevention, 3 not only increases the risk of incident hypertension but also is associated with an increased risk of cardiovascular disease (CVD).4-7 Although prehypertension is not addressed by the eighth Joint National Committee on Prevention, 8 the diagnosis of prehypertension provides a unique understanding of when future CVD trajectories could be changed by lifestyle modifications. 4 Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. [9][10][11] To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed.Pregnancy is a known, long-term cardiovascular stress test for women. The presence of hypertensive disorders in pregnancy (HDP) is generally recognized as a maladaptation to pregnancyinduced hemodynamic and metabolic alterations. 12,13 In addition, Abstract-The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120-139/80-89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11 +0 to 13 +6 weeks' gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37 +0 and 26 +0 weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-Jshaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79-23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measur...

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Cardiometabolic Consequences of Gestational Dysglycemia

Cited by 43 publications

References 67 publications

History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women

History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women

Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups

Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors

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