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Elevated BMI plus preeclampsia increases type 2 diabetes risk after pregnancy
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The risk for type 2 diabetes after pregnancy is much higher in women with high BMI and a history of hypertensive disorders of pregnancy, or HDP, such as preeclampsia and gestational hypertension, according to findings published in Diabetes Care.
“Women with a history of HDP may additionally benefit from maintaining a healthy weight, as post-pregnancy BMI modifies the association between HDP history and incident chronic hypertension,” Simon Timpka, PhD, a postdoctoral fellow and assistant researcher with the genetic and molecular epidemiology unit at Lund University in Sweden, and colleagues wrote. “However, it is currently unknown whether maintaining a healthy BMI is of greater importance in the prevention of type 2 diabetes for women with a history of HDP compared with women without such a history.”
Data from the Nurses’ Healthy Study II were utilized by Timpka and colleagues, providing a sample size of 56,159 women (mean age, 46.3 years) after exclusions. All participants were aged 45 to 54 years. A total of 6,563 women in the cohort, which represented 11.7% of the total, had a history of HDP (mean age, 46.3 years). Follow-up began in 1991 and finished in 2013, including a 2009 reproductive history questionnaire that confirmed preeclampsia or gestational hypertension in the cohort. Questionnaires sent biennially confirmed type 2 diabetes diagnosis during the study period.
During follow-up, 1,341 women received a type 2 diabetes diagnosis. BMI had a strong association with diabetes risk regardless of HDP. The researchers noted that a history of HDP doubled the risk for type 2 diabetes in women with normal weight (HR = 2.08; 95% CI, 1.06-4.06) compared with women with no HDP history and normal weight. An additive interaction was found for type 2 diabetes risk when a participant had higher BMI and a history of HDP (P = .004).
The relative excess risk for type 2 diabetes in women with BMI greater than 35 kg/m2 and a history of HDP (obesity class II) was 14.02 (95% CI, 2.83-25.22) compared with an RR of 10.69 (95% CI, 3.67-17.7) in those with BMI between 30 kg/m2 and 34.9 kg/m2 (obesity class I) and 0.98 (95% CI, –1.92 to 3.87) in those with BMI between 25 kg/m2 and 29.9 kg/m2 (overweight). The amount of risk attributable to the combined effect of BMI and an HDP history was highest in women with obesity class I (36%; 95% CI, 13-59) vs. women with obesity class II (24%; 95% CI, 5-42) and women with overweight (12%; 95% CI, –22 to 46).
“Our results suggest that the risk of type 2 diabetes was above and beyond that expected for women with both high BMI and a history of HDP,” the researchers wrote. “This study further supports that history of HDP is a marker of metabolic susceptibility, which may synergistically interact with BMI in the years after pregnancy to further increase the risk of type 2 diabetes.” – by Phil Neuffer
Disclosures: Timpka reports he received an international postdoctoral grant from the Swedish Research Council. Please see the study for all other authors’ relevant financial disclosures.
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