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Combined gestational diabetes, hypertension increase risk for type 2 diabetes, prediabetes
Chinese women with combined gestational diabetes and hypertension during pregnancy or chronic hypertension after delivery were more likely to go on to develop prediabetes or type 2 diabetes than women with gestational diabetes who were normotensive during pregnancy, according to recent study findings.
“For women with prior gestational diabetes, gestational hypertension and chronic hypertension at the interconception examination were risk factors for type 2 diabetes,” Gang Hu, MD, MPH, PhD, assistant professor at the Chronic Disease Epidemiology Laboratory at Pennington Biomedical Research Center in Baton Rouge, Louisiana, told Endocrine Today. “Our results provide evidence for future randomized controlled trials to prevent type 2 diabetes in women [with gestational diabetes and] hypertension during pregnancy. High blood pressure levels should call health care providers’ attention to prevent diabetes in women at risk during pregnancy.”
Gang Hu
In a retrospective, population-based study, Hu, Xiaojing Yuan, MPH, of the Pennington Biomedical Research Center, and colleagues analyzed data from 1,261 women with a history of gestational diabetes between 2005 and 2009 in Tianjin, China. All women completed a postpartum baseline survey, a 3-day 24-hour food recall, a food frequency questionnaire and physical activity assessment. Women who self-reported diagnosed gestational hypertension, preeclampsia or eclampsia after 20 weeks of gestation on the questionnaire were classified as having gestational hypertension at baseline. Researchers used logistic and Cox regression analyses to assess associations between gestational hypertension, chronic hypertension after pregnancy, the use of antihypertensive drugs and risks for prediabetes and type 2 diabetes.
Within the cohort, 89 women had gestational hypertension during their index pregnancy; 94 women had chronic hypertension at the interconception exam.
Women with gestational diabetes and hypertension who did not use antihypertensive drugs during their pregnancy were 3.94 times more likely to develop type 2 diabetes after delivery vs. women with gestational diabetes who were normotensive during their index pregnancy (95% CI, 1.94-8.02). Across all models, researchers found that systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg was associated with type 2 diabetes risk (OR = 3.38; 95% CI, 1.66-6.87) vs. women with normal BP. Using systolic and diastolic BP as continuous variables, adjusted ORs for developing type 2 diabetes were 1.24 for each 5-mm Hg increase in systolic BP (95% CI, 1.03-1.52) and 1.49 for each 5-mm Hg increase in diastolic BP (95% CI, 1.18-1.88).
When compared with women who were normotensive during and between pregnancies, relative risk for type 2 diabetes was highest among women who had gestational hypertension and interconception hypertension (OR = 7.12; 95% CI, 2.56-19.8), followed by women who had gestational hypertension alone (OR = 5.46; 95% CI, 2.71-11) and women with hypertension only at the interconception examination (OR = 4.53; 95% CI, 2.23-9.22). Chronic hypertension at the interconception exam alone was independently associated with prediabetes among women with prior gestational diabetes (OR = 4.04; 95% CI, 2.3-7.11), as was combined gestational hypertension and interconception hypertension (OR = 3.14; 95% CI, 1.19-8.27).
Researchers found no evidence of interaction between gestational hypertension and interconception hypertension with type 2 diabetes risk, although both were associated with type 2 diabetes risk. – by Regina Schaffer
For more information:
Gang Hu, MD, MPH, PhD, can be reached at the Chronic Disease Epidemiology Laboratory at Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808; email: gang.hu@pbrc.edu.
Disclosure: Hu reports no relevant financial disclosures.