Early cardiovascular events in women with a history of gestational diabetes mellitus

Abstract

BackgroundThe effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.MethodsThis nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions.ResultsThe hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09–1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29–2.20]), myocardial infarction (aOR = 1.92 [1.36–2.71]) and hypertension (aOR = 2.72 [2.58–2.88]) but not with stroke.ConclusionsA history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported.

Long‐term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and meta‐analysis with more than 2 million women

“…Twenty five cohorts reported the diagnostic criteria for diabetes being used: 7 utilized the WHO's 1985 criteria (17,18,22,23,33,39,44), 6 with the ADA's (24,27,30,38,43,45), 5 used the WHO's 1999 criteria (1999) (18,25,29,34,46), 4 used local or self-reported criteria (31,35,36,41), 1 with the National Diabetes Surveillance System's (NDSS) (32), and the Carpenter-Coustan's modification of the National Diabetes Data Group criteria (42), respectively. According to the study design, 7 out of 30 were retrospectvie cohort studies (21,23,26,36,37,39,42), while the others were prospective ones.…”

Development of an algorithm to identify pregnancy episodes and related outcomes in health care claims databases: An application to antiepileptic drug use in 4.9 million pregnant women in France

“…In France, despite growing interest in pregnancy research using claims databases, no algorithm has yet been published. However, some studies have explicitly reported the discharge diagnoses or medical procedures used to identify pregnancies . Most studies were restricted to births, and only a few studies included abortion and ectopic pregnancies …”

“…2 A few articles have been specifically devoted to this challenge, using the Clinical Practice Research Datalink 2,3 or North American claims databases. 1,[4][5][6][7][8] In France, despite growing interest in pregnancy research using claims databases, [9][10][11][12][13][14][15][16] no algorithm has yet been published. However, some studies have explicitly reported the discharge diagnoses or medical procedures used to identify pregnancies.…”

“…However, some studies have explicitly reported the discharge diagnoses or medical procedures used to identify pregnancies. [9][10][11]13,16 Most studies were restricted to births, and only a few studies included abortion and ectopic pregnancies. 9,12,14,16 The primary objective of this study was therefore to develop an algorithm to identify pregnancy episodes and related outcomes using the French health care databases, which covers 99% of the 67 million inhabitants in France.…”

Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update

“…During this time, 14.9% of the nonobese women with a history of GDM developed hypertension; the hazard ratio, adjusted for maternal age, preeclampsia, parity, smoking status, ethnicity, and socioeconomic status, was 2.0 (1.8–2.2); and in the obese women with a history of GDM, the rate of hypertension rose to 26.8% and the hazard ratio to 3.7 (3.2–4.3). Goueslard et al [17] recently reported on a large nationwide population-based retrospective study conducted in France, with a follow-up of 7 years. They considered 62,958 women with and 1,452,429 women without a history of GDM.…”