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Gestational diabetes increases CV risk
Cardiovascular risk is elevated in women with gestational diabetes regardless of whether type 2 diabetes develops, study data show.
Ravi Retnakaran, MD, FRCPC, clinician-scientist and endocrinologist at Leadership Sinai Centre for Diabetes and Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Toronto) and associate professor in the department of medicine at the University of Toronto, and Baiju R. Shah, MD, PhD, associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto, evaluated data from 1,515,079 women from Ontario, Canada, with a live-birth pregnancy between April 1994 and March 2014 to assess the role of type 2 diabetes in vascular outcomes.
Participants were divided into four groups: women with gestational diabetes who developed type 2 diabetes (n = 15,585; median age, 32 years), women with gestational diabetes who did not develop type 2 diabetes (n = 41,299; median age, 32 years), women without gestational diabetes who developed type 2 diabetes (n = 49,397; median age, 31 years) and women without gestational diabetes or type 2 diabetes (n = 1,408,798; median age, 30 years; reference group). Follow-up was a median 10 years.
Participants who developed diabetes had increased risks for retinopathy (gestational diabetes then diabetes group, P < .0001; no gestational diabetes then diabetes group, P < .0001), initiation of dialysis (gestational diabetes then diabetes group, P < .0001; no gestational diabetes then diabetes group, P < .0001) and hospitalization for foot infection (gestational diabetes then diabetes group, P < .0001; no gestational diabetes then diabetes group, P < .0001) compared with no increased risks in the reference group and the gestational diabetes but no diabetes group.
Compared with the reference group, there were increased risks for CVD events in the gestational diabetes then diabetes group (P < .0001), no gestational diabetes then diabetes group (P < .0001) and gestational diabetes but no diabetes group (P < .0001); the same was true for coronary artery disease events (gestational diabetes then diabetes group, P< .0001; no gestational diabetes then diabetes group, P < .0001; gestational diabetes but no diabetes group, P < .0001).
“Although event rates are low, women in whom [gestational diabetes] is diagnosed have an elevated risk for the future development of CVD and CAD, whether or not [type 2 diabetes] develops in the years after the pregnancy,” the researchers wrote. “Progression to [type 2 diabetes] only modifies the magnitude of this risk increment. In contrast, the risks of advanced retinopathy, nephropathy and foot infection outcomes are only increased in women in whom [type 2 diabetes] develops. Thus, future macrovascular risk is an inherent feature of [gestational diabetes], irrespective of subsequent [type 2 diabetes], whereas microvascular risk emerges only in those in whom [type 2 diabetes] develops.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.