Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study

McKenzie‐Sampson, Safyer; Paradis, Gilles; Healy‐Profitós, Jessica; St‐Pierre, Frédérique; Auger, Nathalie

doi:10.1007/s00592-017-1099-2

Cited by 100 publications

(86 citation statements)

References 29 publications

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“…1). Nine studies met our inclusion criteria [6,8,9,[15][16][17][18][19][20] and were included in the analysis, providing data on 5,390,591 women and 101,424 cardiovascular events (8003 in women with GDM and 93,421 in women without GDM). Table 1 summarises the included studies, which were all published between 2013 and 2018.…”

Section: Resultsmentioning

confidence: 99%

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis

2019

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Aims/hypothesis Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of type 2 diabetes mellitus. Recently, a series of studies has suggested that women with GDM also have an increased risk of cardiovascular disease (CVD). However, it is unclear if this risk is dependent upon the intercurrent development of type 2 diabetes. Thus, we conducted a systematic review and meta-analysis to evaluate the impact of GDM on future risk of incident CVD and to ascertain the role of type 2 diabetes in this regard. Methods We systematically searched the PubMed and EMBASE databases for observational studies that evaluated the association of GDM with subsequent CVD, with publication between 1 January 1950 and 30 August 2018. Two independent reviewers extracted data and the analysis was performed in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. RRs were calculated using a random-effects model to assess the predictive value of GDM for future cardiovascular events. To evaluate whether incident type 2 diabetes in the GDM population influenced the association with CVD, we used meta-regression models followed by sensitivity analyses restricted to women who did not develop type 2 diabetes during follow-up. Results A pooled analysis of nine studies yielded data from 5,390,591 women (101,424 cardiovascular events). Compared with those who did not have GDM, women with GDM had a twofold higher risk of future cardiovascular events (RR 1.98 [95% CI 1.57, 2.50]). Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk (p = 0.34). Moreover, when restricted to women who did not develop type 2 diabetes, GDM remained associated with a 56% higher risk of future cardiovascular events (RR 1.56 [95% CI 1.04, 2.32]). GDM conferred a 2.3-fold increased risk of cardiovascular events in the first decade postpartum (RR 2.31 [95% CI 1.57, 3.39]). Conclusions/interpretation The diagnosis of GDM identifies young women who have a twofold higher risk of cardiovascular events postpartum compared with their peers. This risk is not dependent upon intercurrent type 2 diabetes and is apparent within the first decade after pregnancy. Thus, even without progressing to type 2 diabetes, women with GDM comprise an at-risk population for CVD and hence a potential opportunity for early risk factor surveillance and risk modification.

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Section: Resultsmentioning

confidence: 99%

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis

2019

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“…These maternal cardiometabolic disorders have been identified as risk factors for longterm cardiovascular disease. [31][32][33][34][35][36][37][38][39]…”

Section: What Do Pregnancy Complications Indicate About Future Risk Omentioning

confidence: 99%

“…38 In 2018, a Canadian retrospective cohort study involving over 1 million women showed an association between gestational diabetes and elevated ischemic heart disease (HR 1.23, 95% CI 1.12-1.36) and MI (HR 2.14, 95% CI 1.15-2.47) as much as 25 years after the index pregnancy. 39…”

Section: Maternal Dysglycemiamentioning

confidence: 99%

Identifying and managing younger women at high risk of cardiovascular disease

Srivaratharajah

Abramson

2019

CMAJ

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C ardiovascular disease (CVD), which is largely preventable, is a leading cause of morbidity and mortality among Canadian women. For this article, we use CVD to refer to ischemic heart disease and stroke. Data for peripheral arterial disease in women are limited and are addressed elsewhere. 1 Until now, risk reduction has focused largely on postmenopausal woman with traditional risk factors: diabetes, smoking, hypertension and hyperlipidemia. Consequently, CVD mortality has declined, largely driven by those aged 50 years and older. 2 A recent study of 20-year temporal trends in admissions to hospital and deaths caused by atherosclerotic cardiovascular disease in Ontario reported that mortality rates for circulatory diseases in women declined 52.8% between 1994 and 2012. 3 However, annual rates of decline were least evident in individuals younger than 50 years of age, suggesting that CVD among younger adults remains a cause for concern. 3 The lowest rate of decline in CVD-related mortality and, in some cases, an increase in CVD-related admissions to hospital and mortality have been observed in younger women. 3,4 Contemporary Canadian data suggest the gap in cardiovascular mortality between men and women may be closing. 5 Yet young women with ST-segment elevation myocardial infarction (MI) have 15%-20% higher rates of death than men of similar age. 6 Whether this is related to systematic differences in care or true biological differences, or a combination, is unclear. What is clear is that addressing cardiovascular health in women younger than 50 years of age requires thinking beyond traditional risk factors in primordial prevention. We present a brief overview of sex differences in traditional cardiovascular risk factors and a focused review of key nontraditional risk factors in younger women (i.e., ovarian dysfunction, infertility, reproductive therapies and pregnancy complications). Our approach to gathering evidence is outlined in Box 1.

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“…There now exists a plethora of literature detailing the relationship between pregnancy complications (including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, idiopathic preterm birth, and placental abruption) and an increased risk of future CVD (11)(12)(13)(14)(15)(16)(17)(18)(19). During pregnancy, maternal physiology undergoes complex and substantial changes, resulting in heightened organ function to cope with fetal demand and to maintain pregnancy (20).…”

Section: Introductionmentioning

confidence: 99%

A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population

Aldridge

Verburg

Sierp

et al. 2020

Front. Cardiovasc. Med.

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Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study

Abstract: In this population of pregnant women, gestational diabetes was associated with an increased risk of heart disease 25 years after delivery. Women with gestational diabetes may merit closer monitoring for cardiovascular disease prevention after pregnancy.

Cited by 100 publications

References 29 publications

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis

Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis

Identifying and managing younger women at high risk of cardiovascular disease

A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population

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