Gestational diabetes increases risks for CV, cerebrovascular diseases
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Women with gestational diabetes have increased risks for overall and specific types of cardiovascular and cerebrovascular diseases, whether or not they go on to develop type 2 diabetes, according to study data published in The BMJ.
“Major findings from the study convey a hopeful and powerful message to women at exceptionally high risk, women who first develop diabetes in pregnancy,” Cuilin Zhang, MD, PhD, MPH, director of the Global Center for Asian Women’s Health and professor in the department of obstetrics and gynecology at Yong Loo Lin School of Medicine at the National University of Singapore, Singapore, told Healio. “Even though these women have a much greater risk of type 2 diabetes, adopting a healthy diet and lifestyle can lower up to 90% risk of type 2 diabetes and even alleviate the high genetic risk of type 2 diabetes.”
Researchers searched PubMed, Embase and the Cochrane Library through November 2021 and identified 15 observational studies that reported on the association between gestational diabetes and incident CV and cerebrovascular diseases. Researchers quantified risks for overall and type-specific CV and cerebrovascular diseases and thromboembolism among women with a history of gestational diabetes.
Of the 513,324 women with gestational diabetes, 9,507 women had CV and cerebrovascular disease. Of the more than 8 million controls without gestational diabetes, 78,895 women had CV and cerebrovascular disease.
Women with gestational diabetes history had a 45% increased risk for overall CV and cerebrovascular disease (RR = 1.45; 95% CI, 1.36-1.53), a 72% increased risk for CVD (RR = 1.72; 95% CI, 1.4-2.11) and a 40% increased risk for cerebrovascular diseases (RR = 1.4; 95% CI, 1.29-1.51) compared with women without gestational diabetes.
In addition, women with gestational diabetes had an increased risk for incident coronary artery disease (RR = 1.4; 95% CI, 1.18-1.65), myocardial infarction (RR = 1.74; 95% CI, 1.37-2.2), heart failure (RR = 1.62; 95% CI, 1.29-2.05), angina pectoris (RR = 2.27; 95% CI, 1.79-2.87), CV procedures (RR = 1.87; 95% CI, 1.34-2.62), stroke (RR = 1.45; 95% CI, 1.29-1.63) and ischemic stroke (RR = 1.49; 95% CI, 1.29-1.71). Women with gestational diabetes also had a 28% increased risk for venous thromboembolism (RR = 1.28; 95% CI, 1.13-1.46).
In subgroup analyses of CV and cerebrovascular disease outcomes, patients were stratified by study characteristics and adjustments. This demonstrated significant differences by region (P = .078), study design (P = .02), source of data (P = .005), study quality (P = .04), adjustment for smoking (P = .03), BMI (P = .01), socioeconomic status (P = .006) and comorbidities (P = .05).
Researchers also noted that CV and cerebrovascular disease risk remained significant when restricted to women who did not develop subsequent overt type 2 diabetes (RR = 1.09; 95% CI, 1.06-1.13).
“More research along this line in populations of other race/ethnicities, such as Asian and Hispanic, is warranted,” Zhang said. “These women are in fact of the highest risk for gestational diabetes. Also, we should develop effective interventions to improve diet and lifestyle among these women at high risk.”
For more information:
Cuilin Zhang, MD, PhD, MPH, can be reached at obqzc@nus.edu.sq; Twitter: @Cuilinchat.
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