Q&A: 'PCPs should be vigilant' about caring for patients who have had gestational diabetes
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Key takeaways:
- Patients with a history of gestational diabetes could face an increased risk for mortality, especially CVD mortality.
- Primary care physicians should be vigilant when caring for these patients.
Patients who have had gestational diabetes could face an increased risk for mortality, according to experts.
Although gestational diabetes has previously been linked to numerous chronic diseases, not many studies have evaluated the connections between gestational diabetes and long-term mortality risk, Yi-Xin Wang, MD, PhD, a professor at the Shanghai Jiao Tong University School of Medicine, in Shanghai, China, and colleagues wrote.
Wang and colleagues conducted a cohort study of 91,426 parous participants to assess those connections.
Healio spoke with Wang to learn more about the study and what primary care physicians should know.
Healio: Why did you decide to research this subject? Why is it important?
Wang: My studies have primarily focused on investigating the long-term health effects of early-life reproductive characteristics, with the potential to enhance our comprehension of disease prevention. In our previous research, we discovered that early-life factors such as irregular or extended menstrual cycles, pregnancy loss, sexual abuse and gestational hypertension were all linked to an elevated risk of long-term mortality. However, there has been limited exploration of the relationship between gestational diabetes and the long-term risks of both overall and cause-specific mortality in prospective studies.
It's noteworthy that gestational diabetes is progressively surging in prevalence, impacting an estimated 14.2% of pregnant individuals on a global standardized scale. In the United States, the age-standardized rate of gestational diabetes has surged from 47.6 per 1,000 live births in 2011 to 63.5 in 2019 across all racial and ethnic groups. Furthermore, a burgeoning body of evidence has substantiated links between gestational diabetes and type 2 diabetes, cancer, chronic hypertension and CVD, indicating a plausible association between gestational diabetes and the long-term risk of mortality. Moreover, it remains uncertain whether the relationship between gestational diabetes and mortality is influenced by varying patterns of gestational diabetes, including recurrence across multiple pregnancies, co-occurrence with other adverse pregnancy or perinatal outcomes and the subsequent development of type 2 diabetes.
Healio: Will you briefly describe your findings and their clinical implications?
Wang: In our study of 91,426 participants in the Nurses' Health Study II, we identified a noteworthy association between a history of gestational diabetes and an elevated risk of mortality, particularly in cases of CVD mortality, even in instances where subsequent type 2 diabetes did not develop. This association was notably more pronounced among participants who exhibited various risk factors, including a poor-quality diet, heavy smoking habits, overweight or obesity, low levels of physical activity, excessive alcohol intake, hypercholesterolemia, chronic hypertension and preexisting CVD. Furthermore, our research indicated a heightened risk of mortality among individuals who experienced gestational diabetes in two or more pregnancies, those who had gestational diabetes in both their initial and subsequent pregnancies and those who encountered other adverse pregnancy or birth outcomes.
These findings underscore the significance of health care professionals taking gestational diabetes into account when assessing the long-term mortality risk of their patients, particularly among those with severe metabolic disorders, less healthy lifestyle habits and those who have experienced recurrent gestational diabetes or multiple adverse maternal and fetal pregnancy outcomes.
Remarkably, our study also unveiled an unexpected inverse association between a history of gestational diabetes and cancer mortality. This inverse relationship persisted exclusively among participants who reported both gestational diabetes and subsequent type 2 diabetes following a pregnancy with gestational diabetes. We suspect that this unexpected finding may be partially attributed to early detection, the management of medical conditions and lifestyle modifications (eg, maintaining or reducing BMI, adopting a healthy diet and engaging in physical activity), which are often recommended to individuals with type 2 diabetes.
Healio: What is the take-home message for PCPs? What should they know about your study?
Wang: Our take-home message is that PCPs should be vigilant when caring for patients with a history of gestational diabetes, as they may be at an increased risk of mortality, particularly CVD mortality. Close monitoring and management, along with attention to lifestyle factors and potential metabolic disorders, can be crucial in improving the long-term health outcomes of these patients.
Healio: Is there anything else you would like to add?
Wang: Although our findings align with biological plausibility and are consistent with several prior studies, it's important to acknowledge the constraints of our observational study design, which prevent us from establishing any causal relationships. Other limitations of our study include a limited number of non-CVD and non-cancer-related death cases, reliance on self-reported gestational diabetes and a lack of data concerning the presence of prediabetes, gestational age at the onset of gestational diabetes and the severity of the condition.
However, it's essential to emphasize that individuals cannot be randomized to experience gestational diabetes. Consequently, high-quality cohort studies, including our present one, represent the most robust approach to shed light on the relationship between gestational diabetes and long-term health outcomes, including mortality.