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

Abstract

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.

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

“…all the studies in this meta-analysis were published within the past 6 years); (2) the range of risk estimates that these studies have provided; and (3) uncertainty over whether the cardiovascular risk is entirely dependent upon type 2 diabetes. An earlier meta-analysis [23] included fewer studies and its risk estimate was compromised by the inclusion of two studies from our group that had overlapping participant populations [4,9] and studies with self-reported outcomes [7,24], as well as no assessment of the role of type 2 diabetes. The current meta-analysis was thus designed to address these gaps.…”

Gestational diabetes and long-term risk for dyslipidemia: a population-based historical cohort study

“…While it has been suggested14 that women with GDM history are characterized by higher prevalence of dyslipidemia compared with their normoglycemic peers, analysis of parous women from the 2007 to 2014 cycles of the National Health and Nutrition Examination Survey indicated that history of GDM is not significantly related with increasing levels of LDL-C 15. Thus, the aims of the current historical cohort study were to assess the course of lipid levels over time in postpartum women according to gestational diabetes status, taking into account potential confounders, such as comorbid conditions and body weight.…”

Outdoor Air Pollution and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…In different populations and geographical regions, the risk of developing T2D is 7.4 higher among women with GDM in comparison with women without GDM, both postpartum and later in life (6)(7)(8). In addition, young women with GDM are at greater risk of developing cardiovascular diseases (CVD) and coronary artery diseases (CAD), much attributable to the development of T2D (9,10). Moreover, there is reportedly increased risk of preeclampsia, asymptomatic bacteriuria, pyelonephritis and cesarean delivery among women with GDM (11,12).…”

“…Moreover, there is reportedly increased risk of preeclampsia, asymptomatic bacteriuria, pyelonephritis and cesarean delivery among women with GDM (11,12). Besides the adverse effects of GDM on the mother both in the short and long-terms, GDM was linked with many fetal and neonatal complications including macrosomia (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), shoulder dystocia (17), neonatal hypoglycemia (18) and congenital malformation (19)(20)(21).…”