Good glycemic control of gestational diabetes mellitus is associated with the attenuation of future maternal cardiovascular risk: a retrospective cohort study

Abstract

Background To examine whether glycemic control of gestational diabetes mellitus (GDM) could modify the risk for future maternal metabolic and cardiovascular morbidities. Methods A retrospective cohort study of women with a first diagnosis of GDM who delivered between 1991 and 2011. Women were divided into groups of good and poor glycemic control, defined as a mean daily glucose of up to 95 mg/dL (N = 230) and more than 95 mg/dL (N = 216), respectively. In addition, a control group of women without GDM (N = 352) was also analyzed. The primary outcomes were the development of type 2 diabetes mellitus (T2DM), obesity, hypertension, or dyslipidemia. Results Mean follow-up time was 15.8 ± 5.1 years. Assessment was performed at a maternal age of 45 ± 7 years. The rates of the study outcomes in the control, GDM with good glycemic control and GDM with poor glycemic control were as follows: T2DM [19 (5.4%), 87 (38%), 127 (57%)]; hypertension [44 (13%), 42 (18%), 44 (20%)]; obesity [111 (32%), 112 (48%), 129 (58%)]; and dyslipidemia [49 (14%), 67 (29%), 106 (48%)]. Glycemic control was an independent risk factor for T2DM in multivariate Cox regression analysis (hazard ratio (HR) for poor glycemic control vs. controls 10.7 95% CI [6.0–19.0], good glycemic control vs. control HR 6.0 [3.3–10.8], and poor glycemic control vs. good glycemic control HR 1.8 [1.3–2.4]). Glycemic control was also an independent risk factor for dyslipidemia (poor glycemic control vs. controls HR 3.7 [2.3–5.8], good glycemic control vs. controls HR 2.0 [1.2–3.2], and poor glycemic control vs. good glycemic control HR 1.8 1.8 [1.3–2.6]). The fasting glucose level during oral glucose tolerance test (OGTT) was also an independent risk factor for these complications. The interaction term between glycemic control and the fasting value of the OGTT was not statistically significant, suggesting that the effect of glycemic control on the rate of future T2DM and dyslipidemia was not modified by the baseline severity of GDM. Conclusion GDM and especially poor glycemic control are associated with T2DM and dyslipidemia. Strict glycemic control for reducing that risk should be evaluated in prospective trials.

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

“…The 20 studies included in this systematic review and meta-analysis had differing lengths of follow-up, time of screening, ethnic origin of study participants, and diagnostic criteria for both GDM and T2DM 2728313334353637383940414243444546474849. All studies were observational, seven were described as prospective cohorts, six as retrospective cohorts, four as population based studies, two as follow-up studies, and one as a hospital based study.…”

“…As screening criteria have changed, with the cut-off level of fasting plasma glucose for T2DM being lowered from 7.8 to 7.0 mmol/L in 1997,54 this could have led to an underestimation of the overall risk of subsequent T2DM in women with previous GDM. Some of our included studies, however, involved both women diagnosed with the criteria used before 1997, and women diagnosed with the revised criteria 313435363841434849. Additionally, previous systematic reviews have focused on a specific ethnic group,14 or included studies with short term follow-up (≤6 months) 1214.…”

Metformin Ameliorates Gestational Diabetes Mellitus-Induced Endothelial Dysfunction via Downregulation of p65 and Upregulation of Nrf2

“…GDM influences about 3%–25% pregnancies worldwide and the increasing incidence of GDM is mainly due to the increasing prevalence of short- and long-term complications and adverse pregnancy outcomes in GDM mother and offspring, such as type 2 diabetes mellitus (T2DM) or other metabolic disorders ( Thorpe et al., 2005 ; Moyer VA, 2014 ; Jovanovič et al., 2015 ). GDM is considered a prediabetic state, while it shares a series of typical pathophysiological characteristics with type 2 diabetes including insulin resistance, hyperglycemia, biochemical abnormalities, and hyperlipidemia ( Yefet et al., 2019 ). A great number of reports have revealed that the microvascular cell and vascular endothelial cell (VECs) dysfunctions occurred in the umbilical cord and placenta in GDM might lead to immediate or long-term cardiovascular disease risk ( Di Fulvio et al., 2014 ; Sultan et al., 2015 ; Zhou et al., 2016 ; Amrithraj et al., 2017 ).…”

Effect of mobile health based peripartum management of gestational diabetes mellitus on postpartum diabetes: A randomized controlled trial

“…There was a general agreement that maternal outcomes are directly correlated with the degree of glycemic control. Yefet E et al [41] in retrospect a cohort of 789 women with a first diagnosis of GDM and demonstrated that glycemic control was an independent risk factor for T2DM and poor glycemic control were correlated with T2DM. In our study, the glycemic control rate of women who were diagnosed with T2DM was lower than those women without T2DM, however, the significance was not found, which may account for the small population of postpartum T2DM.…”