Hypertension Risk Subsequent to Gestational Dysglycemia Is Modified by Race/Ethnicity

Abstract

Gestational diabetes mellitus is associated with an increased risk of type 2 diabetes mellitus and hypertension. Additionally, gestational dysglycemia has been associated with an increased risk of type 2 diabetes mellitus but not yet associated with hypertension subsequent to pregnancy in long-term follow-up. Therefore, we set out to examine this relationship as well as the role of race/ethnicity in modifying this relationship. We analyzed a prospective observational cohort followed between 1998 and 2007. There were 17 655 women with self-reported race/ethnicity and full-term, live births. A 1-hour 50 g oral glucose-load test and a 3-hour 100 g oral glucose-tolerance test enabled third trimester stratification of women into 1 of 4 glucose-tolerance groups: (1) normal (n=15 056); (2) abnormal glucose-load test (n=1558); (3) abnormal glucose-load and -tolerance tests (n=520); and (4) gestational diabetes mellitus (n=521). Women were then followed for a mean±standard deviation of 4.1±2.9 years after delivery for the development of hypertension. Although gestational diabetes mellitus was associated with an increased risk of hypertension after pregnancy (odds ratio [95% confidence interval]: 1.58 [1.02, 2.45]; P=0.04), dysglycemia defined by an abnormal glucose-load test predicted hypertension only among black women (4.52 [1.24, 16.52]; P=0.02). The risk of hypertension after pregnancy among dysglycemia groups not meeting criteria for gestational diabetes mellitus varied based on the race/ethnicity of the population. Further research on the implications of the intersection of race/ethnicity and gestational dysglycemia on subsequent hypertension is warranted.

Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health

“…We found that race/ethnicity was the stronger predictor of postpartum cardio-metabolic risk, with African American and Latina women having higher postpartum cardio-metabolic risk as compared to White women. Presence of a prenatal cardio-metabolic disease further increased this risk, which is consistent with past research (Bentley-Lewis, et al, 2016; Bentley-Lewis, et al, 2014; Kousta, et al, 2006). This highlights differences in disease risk and burden experienced by African American and Latina women.…”

“…Moreover, low SES has also been associated with increased risk for developing cardio-metabolic diseases in pregnancy (Silva, et al, 2008; Steegers, et al, 2010). Despite these findings, few studies examine all three risk factors together, and only three studies have explored whether race/ethnicity and prenatal cardio-metabolic diseases interact in predicting risk of postpartum cardio-metabolic health (Bentley-Lewis, Huynh, Li, Wenger, & Thadhani, 2016; Bentley-Lewis, et al, 2014; Kousta et al, 2006).…”

“…A second study of 850 participants found that women of African-Caribbean descent with gestational diabetes had worse cardio-metabolic risk and increased risk for metabolic syndrome compared to White women with gestational diabetes (Kousta, et al, 2006). A third study of 17,655 women found that abnormal blood glucose during pregnancy was associated with increased postpartum hypertension risk only among African American women, but not among White, Latina or Asian women, independent of maternal education and covariates (Bentley-Lewis, et al, 2016). Although African American and Latina women with a prenatal cardio-metabolic disease (dysregulated blood sugar) had increased postpartum cardio-metabolic risk, only one of these studies controlled for any indicator of SES (Bentley-Lewis, et al, 2016).…”

“…A third study of 17,655 women found that abnormal blood glucose during pregnancy was associated with increased postpartum hypertension risk only among African American women, but not among White, Latina or Asian women, independent of maternal education and covariates (Bentley-Lewis, et al, 2016). Although African American and Latina women with a prenatal cardio-metabolic disease (dysregulated blood sugar) had increased postpartum cardio-metabolic risk, only one of these studies controlled for any indicator of SES (Bentley-Lewis, et al, 2016). This raises the question: Does having two or more of these three factors - being poor, African American or Latina, and having had a prenatal cardio-metabolic disease - increase risk of postpartum cardio-metabolic risk beyond their single contributions?…”

Emergent Acute Hypertension During Pregnancy-Anomaly or Future Trend?

“…Obesity (reported as BMI over 30 in this study) and ethnicity have previously been reported as risk factors [20,21]. Yet, in this study those factors were not statistically significant as predictors for gestational hypertension.…”