Impaired Fasting Glucose and Impaired Glucose Tolerance in Women With Prior Gestational Diabetes Are Associated With a Different Cardiovascular Profile

Abstract

OBJECTIVE -The purpose of this study was to investigate the association of cardiovascular risk factors to impaired glucose tolerance (IGT) and to impaired fasting glucose (IFG) in women with prior gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -We studied 838 women with prior GDM. Postpartum glucose tolerance status was classified as normal, IFG, IGT, IFG plus IGT, and diabetes according to the World Health Organization criteria. Postpartum BMI, waist circumference, blood pressure, triglyceride, cholesterol, and HDL cholesterol were assessed.RESULTS -BMI and blood pressure were significantly higher in women with IFG than in women with normal glucose status. BMI and waist circumference were significantly higher in women with IFG plus IGT than in women with normal glucose status. No differences were observed between women with IGT and normal glucose status. The prevalence of hypertension and obesity was significantly increased in IFG compared with normal glucose status. The prevalence of obesity and abnormal lipids was significantly increased in IFG plus IGT compared with normal glucose status. IGT showed no increased prevalence of cardiovascular risk factors.CONCLUSIONS -Traditional cardiovascular risk factors have a stronger association with isolated IFG than with isolated IGT in women with prior GDM. Diabetes Care 26:2318 -2322, 2003W omen with gestational diabetes mellitus (GDM) are at an increased risk for the development of diabetes (usually type 2) after pregnancy (1). Likewise, women with prior GDM, when compared with women with no history of GDM, are found to have higher BMI (2), higher blood pressure (3,4), and an altered lipid profile with increased LDL cholesterol and triglyceride levels and decreased HDL cholesterol levels (2-4). Furthermore, changes in endothelial function (5) and increased levels of adhesion molecules (6), together with a higher prevalence of microalbuminuria (7), abnormal electrocardiograms, and cardiovascular events (3) are observed in women with prior GDM. This spectrum of abnormalities is associated with insulin resistance even in situations of normal glucose tolerance (8,9).On the other hand, the establishment of two intermediate categories between normal glucose homeostasis and diabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) (10) has raised concern in which of these disturbances has a major role in predicting the development of type 2 diabetes or cardiovascular disease.The aim of this study was to investigate the association of cardiovascular risk factors to IGT and IFG in the postpartum evaluation of women with GDM. RESEARCH DESIGN AND METHODS -This research was conducted in the Diabetes and PregnancyUnit at the University Hospital La Paz in Madrid between 1992 and 2000. We studied 838 Caucasian women (mean age 32.4 Ϯ 4.6 years; mean parity 1.8 Ϯ 0.9) with singleton gestations complicated by GDM and who attended the initial postpartum assessment (3-6 months after delivery) when lactation was concluded. The total number of women...

Dysglycemia and a History of Reproductive Risk Factors

“…After adjustment for age, most of the reproductive factors remained significantly associated with dysglycemia, including the number of children a woman gave birth to (OR CONCLUSIONS -This large, multiethnic study of middle-aged women showed that a history of GDM is independently associated with prevalent dysglycemia, confirming that pregnancy is a "stress test for life" (9,10). This observation may be understood in light of the fact that the occurrence of GDM is clear evidence of an impaired ability to maintain normoglycemia under the metabolic stress of pregnancy and is consistent with previous reports (11)(12)(13)(14) from smaller studies. Hence, in young women of childbearing age, reproductive factors, particularly GDM, can be used to counsel patients about their future risk of dysglycemia regardless of future BMI, whereas in middle-aged women a history of reproductive risk factors may be useful as a screening tool for dysglycemia.…”

Gestational diabetes mellitus and risk of future maternal cardiovascular disease

“…Among women with a GDM history, blood pressure, HDL and triglyceride levels are elevated and associated with diabetes and milder glucose intolerance [9][10][11][12]. While levels of blood pressure and lipids were elevated compared with controls, these were still usually within normal range and related to glucose continuously, without a threshold effect.…”

Gestational Diabetes

“…The reason for this is not immediately apparent and will require further research. Data are becoming available suggesting that the metabolic associates of impaired fasting glucose are different from those of IGT (14,15). Although the conclusions from these data are by no means concordant, it is possible that deficits of insulin secretion may play a major part in determining the fasting glucose level, whereas insulin resistance may play a major role in determining the postprandial glucose responses.…”