Prior gestational hyperglycemia: A long-term predictor of the metabolic syndrome

Abstract

Little is known about the association between prior gestational hyperglycemia of different severity and the subsequent risk for the metabolic syndrome. Eighty-one women with prior gestational diabetes mellitus (GDM), 25 with one abnormal value at the oral glucose tolerance test (OGTT), and 65 with normal OGTT were studied after a mean of 8.5 yr from the index pregnancy. Patients with prior gestational hyperglycemia (both one abnormal value at the OGTT and GDM) showed a worse metabolic pattern than subjects with gestational normoglycemia [respectively higher values of body mass index (BMI), waist, blood pressure, serum glucose, insulin, C-peptide, homeostatic model assessment (HOMA), fibrinogen and lower levels of HDL-cholesterol]. Prevalence of the metabolic syndrome and its components was 2-4-fold higher in women with prior gestational hyperglycemia (and 10-fold higher if pre-pregnancy obesity coexisted) when compared to normoglycemic controls; in a Cox proportional hazard model, after adjustments for age and pre-pregnancy BMI, gestational hyperglycemia and pre-pregnancy BMI predicted subsequent metabolic syndrome [respectively: hazard ratio (HR)=4.26 and HR=1.21] and most of its components. In the same model, the highest quartile of fasting serum glucose at the OGTT of the index pregnancy was significantly associated to the metabolic syndrome and its components. Gestational hyperglycemia and fasting glucose values were also associated to subsequent fibrinogen values, but not to albumin excretion rates. In young adult women, prior gestational hyperglycemia (particularly abnormal fasting glucose values), above all in combination with pre-pregnancy obesity, anticipates a subsequent syndrome at high cardiovascular risk and, possibly, a mild chronic inflammatory response.

Pre-pregnancy overweight overtakes gestational diabetes as a risk factor for subsequent metabolic syndrome

“…The higher proportion of self-reported medically treated hypertension and dyslipidemia in the GDM women compared with the controls is in line with previous studies (6,7,8). In this study, the prevalence of abnormal lipid concentrations was remarkably high in both groups and unexpectedly, it tended to be higher in the control group.…”

“…Several studies have indicated that history of GDM increases the risk of metabolic syndrome (MS) and cardiovascular diseases (CVD), especially when it is associated with obesity, increased fasting glucose concentration, and excessive weight gain during pregnancy (6,7,8,9,10).…”

Gestational Diabetes and the Metabolic Syndrome

“…Women with previous GDM had a 3-fold higher risk of metabolic syndrome compared to non-GDM controls (Lauenborg et al, 2005). A similar study in Europe reported prevalences of metabolic syndrome of 21% and 4.6%, respectively, 8.5 years' postpartum (Bo et al, 2004b). Indeed, prior gestational hyperglycemia in the absence of fulfilling the overt criteria for GDM results in a future risk of metabolic syndrome 2-4 times that of those with normoglycemia in pregnancy.…”

“…This risk is 10 times higher in women with concomitant pre-pregnancy obesity (Bo et al, 2004a). Thus, even mild gestational hyperglycemia predicts metabolic syndrome (Bo et al, 2004b), and metabolic syndrome is increasingly more likely to develop over time following the index pregnancy (Bo et al, 2006). These studies highlight the chronic nature of the metabolic dysfunction associated with GDM.…”

Gestational diabetes mellitus screening and outcomes

“…Women with GDM have been reported to have increased rates of stillbirth, polyhydramnios, gestational hypertension, macrosomia, and cesarean delivery (9). GDM usually resolves after delivery, but it appears that the risk of recurring GDM and type 2 diabetes mellitus are increased in subsequent pregnancies, along with cardiovascular risk later in life (10,11). Although the precise role of the risk factors related to GDM (multiparity, obesity,) has not yet been entirely defined, they may be included in the classification of pregnancy-related or maternal factors (12).…”