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Gestational diabetes may be marker for early atherosclerosis
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History of gestational diabetes appears to be a marker for early atherosclerosis regardless of pre-pregnancy obesity in women with no subsequent diabetes or metabolic syndrome.
Previous research had demonstrated an association between gestational diabetes and increased risk for diabetes and metabolic syndrome; however, it was unknown whether gestational diabetes was associated with greater risk for early atherosclerosis independent of pre-pregnancy obesity and metabolic disease, according to the study background.
Researchers analyzed 898 participants from the CARDIA study (47% black) who were free of diabetes and CVD at baseline in 1985-1986; delivered at least one birth after baseline; reported whether they had had gestational diabetes; and had common carotid intima-media thickness measured in 2005-2006. The average age was 31 years at last birth and 44 years at common carotid intima-media thickness measurement.
Erica P. Gunderson, PhD, MS, MPH, from Kaiser Permanente Northern California, and colleagues performed an analysis adjusted for race, age, parity and pre-pregnancy cardiometabolic risk factors, evaluated mediators such as weight gain, insulin resistance and BP, and assessed the effect modification by incident diabetes or metabolic syndrome during the 20-year follow-up period.
Thirteen percent of participants reported gestational diabetes (7.6 per 100 deliveries).
The unadjusted mean common carotid intima-media thickness was 0.023 mm higher for women who had gestational diabetes compared with women who did not have gestational diabetes (P=.029). However, adjustment for pre-pregnancy BMI attenuated the difference to 0.016 mm (P=.109).
Analysis of the 777 women who did not have subsequent diabetes or metabolic syndrome, adjusted for race, age, parity and pre-pregnancy BMI, showed that mean common carotid intima-media thickness was 0.023 mm higher for women with gestational diabetes compared with women without gestational diabetes (0.784 mm vs. 0.761 mm; P=.039). Adjustment for pre-pregnancy insulin resistance index did not change the results.
Among the 121 women who developed subsequent diabetes or metabolic syndrome, the researchers found no difference in mean common carotid intima-media thickness between the gestational diabetes group and the non-gestational diabetes group (P=.58).
Gestational diabetes “may be considered a risk factor for atherosclerosis before the onset of diabetes or metabolic disease,” Gunderson and colleagues wrote. “Weight gain, insulin resistance, and [BP] increases during the study period partially accounted for the [gestational diabetes-common carotid intima-media thickness] association.
“Our findings suggest that body size, [BP] control, and insulin resistance may be important modifiable risk factors that may influence progression of atherosclerosis in midlife in women with a history of [gestational diabetes].”
Disclosure: The researchers report no relevant financial disclosures.
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