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Gestational diabetes may predict subsequent renal dysfunction
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Danish women with a history of gestational diabetes are more likely to have a higher estimated glomerular filtration rate, an early sign of renal impairment, than women without gestational diabetes, according to findings from a long-term follow-up study published in Diabetes Care.
“Emerging, yet limited, studies have reported an association between [gestational diabetes] history and subsequent renal morbidity,” Shristi Rawal, PhD, a postdoctoral fellow in the epidemiology branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and colleagues wrote in the study background. “However, most of the current evidence has been based on retrospective or cross-sectional analysis, with the most critical limitation being the inadequate control for potential confounding factors, including prepregnancy BMI, which is a major risk factor for [gestational diabetes].”
Rawal and colleagues analyzed data from 607 women with gestational diabetes and 619 women without gestational diabetes participating in the DWH study, a long-term follow-up study of women with gestational diabetes within the Danish National Birth Cohort (1996-2002). At follow-up after the index pregnancy (median, 13 years), researchers measured serum creatinine and urinary albumin levels to derive eGFR and urinary albumin-to-creatinine ratio. Urinary albumin-to-creatinine levels were log-transformed to normalize distribution, and researchers used general linear models to assess differences in log-transformed urinary albumin-to-creatinine ratio and eGFR in women with and without history of gestational diabetes.
By 13 years postpartum, 192 women had developed diabetes, with 113 diagnosed with type 2 diabetes during the follow-up clinical exam and an additional 79 women reporting physician-diagnosed type 1 or type 2 diabetes.
Researchers found that women with gestational diabetes had a higher eGFR vs. women without gestational diabetes, even if they did not develop diabetes after pregnancy (adjusted beta = 3.3; 95% CI, 1.7-5). Additionally, women with gestational diabetes who went on to develop type 2 diabetes after pregnancy (n = 183) had an increased risk for higher urinary albumin-to-creatinine ratio ( 20 mg/g) vs. women without gestational diabetes or subsequent type 2 diabetes (aRR = 2.3; 95% CI, 1.1-5.9). However, after adjusting for prepregnancy BMI and hypertension, gestational diabetes was not associated with urinary albumin-to-creatinine ratio, according to researchers.
In sensitivity analyses that included women with prediabetes in the diabetes category, researchers found that women with gestational diabetes history had a higher eGFR vs. those without gestational diabetes (adjusted beta = 3; 95% CI, 1-5), even if they did not develop prediabetes or overt diabetes after the index pregnancy. Findings persisted when the definition of gestational diabetes was restricted to women with a verified gestational diabetes diagnosis or defined diabetes at follow-up based solely on self-report.
The findings suggest that in women with a history of gestational diabetes, deterioration of renal function may precede the development of overt diabetes, although clinically relevant outcomes such as elevated urinary albumin-to-creatinine ratio may manifest only after the progression to diabetes, the researchers noted.
“These findings suggest that women with [gestational diabetes]-complicated pregnancies may represent a high-risk group that could benefit from regular monitoring for early-stage renal damage, timely detection of which may help clinicians initiate treatment to prevent or delay further disease progression,” the researchers wrote. – by Regina Schaffer
Disclosure: One of the authors reports he is an employee of AstraZeneca.
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