Normal blood glucose after gestational diabetes may indicate ASCVD risk
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Women who developed first-time gestational diabetes and returned to normal blood glucose levels after pregnancy may experience a twofold increased risk for developing atherosclerotic CVD, according to new data from the CARDIA study.
According to research published in Circulation, gestational diabetes was not associated with coronary artery calcification in women with incident diabetes after pregnancy.
“Gestational diabetes may reveal underlying metabolic conditions that can worsen over time with aging and weight gain to increase a woman’s long-term CV health.” Erica P. Gunderson, PhD, MS, MPH, epidemiologist and senior research scientist in the cardiovascular and metabolic conditions section at Kaiser Permanente’s Division of Research in Oakland, California, told Healio. “Even though women with gestational diabetes may later attain normal blood sugar levels, these subtle changes in metabolism may harm the blood vessels and promote the formation of the plaque in her coronary arteries that increases risk for heart disease.”
Using data from the community-based, prospective CARDIA cohort study of young adults aged 18 to 30 years, researchers included 1,133 women (50% Black) without diabetes at baseline who had at least one singleton birth during 25-year follow-up. Data on glucose tolerance testing, gestational diabetes status and CAC measurements (measured by noncontrast cardiac CT) were obtained from one or more examinations at 15, 20 and 25 years.
Overall, 12.3% of women reported development of gestational diabetes during pregnancy. CAC was present in 16.2% of participants.
ASCVD risk after gestational diabetes
In the overall cohort, 15% of women without gestational diabetes had a CAC score greater than 0 during follow-up compared with 24.5% of women with gestational diabetes.
Researchers observed that gestational diabetes was associated with increased risk for ASCVD (HR = 1.85; 95% CI, 1.28-2.69) after adjustment for age, race and prepregnancy systolic BP. Additional adjustment for prepregnancy BMI and time-varying smoking slightly attenuated risk (HR = 1.73; 95% CI, 1.18-2.52), but further adjustment for hypertension did not.
After stratification by diabetes status after pregnancy, gestational diabetes was not associated with presence of CAC in women with incident diabetes but was associated with a twofold increased risk in women with no diabetes (adjusted HR = 2.02; 95% CI, 1.31-3.11). Risk for ASCVD was attenuated slightly after the inclusion of covariates such as prepregnancy BMI, time-varying smoking and time-varying hypertension during follow-up (HR = 1.95; 95% CI, 1.27-3.01).
“Women with gestational diabetes had twice the risk for coronary artery calcium compared to women who never had gestational diabetes, even when both groups had normal blood sugar levels many years after pregnancy,” Gunderson said in an interview. “This is the same increase in relative risk that we found in women with a history of gestational diabetes who had developed prediabetes or were diagnosed with type 2 diabetes during follow up. This means the risk for heart disease may be increased substantially in all women with a history of gestational diabetes, and may not diminish even if their blood sugar remains normal many years later.”
Gestational diabetes in prior pregnancies
In other findings, women who developed gestational diabetes during prior pregnancies were more likely to develop prediabetes or incident diabetes than maintain normoglycemia after pregnancy compared with women with no prior gestational diabetes (P < .001).
“Women with a history of gestational diabetes should be tested for diabetes at regular intervals after pregnancy depending on their risk factors as recommended by the American Diabetes Association,” Gunderson told Healio. “A health care provider should factor in a woman’s history of gestational diabetes when evaluating her risk for heart disease and recommendations for prevention. These women may require more frequent screening and evaluation of established risk factors for atherosclerotic heart disease starting at a younger age, depending on their medical history and their current health factors.
“Research is needed to better characterize the severity of gestational diabetes in relation to future CVD outcomes, including identifying critical pregnancy-related risk factors,” Gunderson said. “We also need more life course studies that follow women from preconception through midlife. We also need to learn more about the effects of breastfeeding and sleep that can help reduce both type 2 diabetes and CVD risks during the first year after a woman gives birth.”
For more information:
Erica P. Gunderson, PhD, MS, MPH, can be reached at erica.gunderson@kp.org.
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