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Screen Women Who Have Had GDM Early For Cardiovascular Disease, Type 2 Diabetes


 

CHICAGO – Data clearly show that women who develop gestational diabetes get cardiovascular disease at much earlier ages–often in their early-to-mid-40s–and should be targeted with preventive management, Dr. Darcy B. Carr said at the annual scientific sessions of the American Diabetes Association.

“Women with prior gestational diabetes should be screened earlier for cardiovascular risk factors, and we should take this opportunity to target them with more interventions aimed at reducing their risk,” said Dr. Carr, of the division of maternal-fetal medicine at the University of Washington, Seattle.

This increased early risk is largely–though perhaps not completely–due to the fact that women who develop gestational diabetes are at increased risk of type 2 diabetes, Dr. Carr said.

“I am sure there are women who do not develop diabetes who still have the cardiovascular risk,” she said.

Studies have shown that one-third to one-half of women with gestational diabetes will develop type 2 diabetes within 5 years, and that 70% will develop type 2 diabetes within 10 years.

Studies have also shown that individuals with gestational diabetes have a higher risk of metabolic syndrome, have more markers of vascular endothelial inflammation after their pregnancy, and also have a greater likelihood of hypertension.

The Nurses Health Study, in which more than 117,000 women were followed for 20 years, was able to demonstrate that the risk of cardiovascular disease (CVD) was tied to the development of type 2 diabetes.

But the study also found that CVD seemed to precede the type 2 diabetes, so that the risk of stroke and myocardial infarction was two to nearly four times times higher in the women who had gestational diabetes even before they were diagnosed with type 2 diabetes, Dr. Carr said (Diabetes Care 2002;25:1129-34).

In a more recent study, Dr. Carr and colleagues looked at data from a study of women with at least two first-degree relatives with type 2 diabetes (Diabetes Care 2006;29:2078-83).

They found that of the 332 women in the study who reported having had gestational diabetes, 93% later developed type 2 diabetes.

That compared with 63% of the 662 patients who had given birth but who had not developed gestational diabetes. The women with gestational diabetes were also diagnosed with type 2 diabetes at a much younger age, a mean of 37 years versus a mean of 46 years.

The study revealed that the women with a history of gestational diabetes were not only more likely to develop coronary artery disease, 12% versus 11%, but also more likely to have a stroke, 6% versus 5%.

But the most important finding of the study was how young the women with a history of gestational diabetes were when they had these events, Dr. Carr said.

The mean age at which the women with gestational diabetes developed their coronary artery disease was 45 years, compared with 52 years for those without gestational diabetes, and the mean age of stroke was 50 years, versus 57 years.

“I think this study has significant implications for women with gestational diabetes,” Dr. Carr said.

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