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Gestational Diabetes Linked to Later CVD Risk : Women with a history of GDM had increased risk factors such as insulin resistance and hypertension.


 

Women who are diagnosed with gestational diabetes during pregnancy may be at greater risk for cardiovascular events later in life, reported Dr. Darcy B. Carr and her associates, of the University of Washington, Seattle.

Previous studies have demonstrated that women with a history of gestational diabetes mellitus (GDM) are at increased risk for a wide array of cardiovascular risk factors, including central adiposity, insulin resistance, dyslipidemia, and hypertension. Now, data from the Genetics of Non-Insulin-Dependent Diabetes (GENNID) study suggest that among women with a family history of type 2 diabetes, these risk factors actually translate into a significantly higher prevalence of cardiovascular disease events in those with prior GDM.

“Interventions have been shown to reduce the progression to type 2 diabetes in subjects at risk for the disease, including women with a history of GDM, and offer primary prevention of cardiovascular disease (CVD) events in established type 2 diabetes. We believe our findings provide a strong rationale to further consider efforts to target women who have a history of GDM with interventions in order to improve both their metabolic and cardiovascular health,” Dr. Carr and her associates wrote (Diabetes Care 2006;29:2078–83).

In GENNID, genetic and phenotypic information was collected at multiple U.S. sites between 1993 and 2001 from families with type 2 diabetes. Among parous women in the study who had a first-degree relative with type 2 diabetes but who did not have pregestational diabetes themselves, a total of 332 reported having had GDM during at least one previous pregnancy, while 662 did not report a history of GDM.

At a mean follow-up of 30 years after the index pregnancy, the women with prior GDM were younger (49 vs. 52 years), more likely to be African American (40% vs. 29%), and less likely to be postmenopausal (48% vs. 58%) than were those without GDM.

Although both groups were obese, women in the prior GDM group had a more atherogenic lipid profile and higher fasting plasma glucose and insulin levels, suggesting increased insulin resistance. Among the risk factors that were reported by significantly more women in the GDM group were history of hypertension (47% vs. 37%), dyslipidemia (34% vs. 26%), and type 2 diabetes (93% vs. 63%). Among women who had these risk factors, those with GDM were diagnosed with them at younger ages: 40 vs. 48 years for hypertension, 48 vs. 52 for dyslipidemia, and 37 vs. 47 for type 2 diabetes.

Women with GDM were more than three times as likely as those without GDMto meet all the criteria for metabolic syndrome, even after adjusting for age, menopausal status, and race/ethnicity, Dr. Carr and her associates reported.

Self-reported history of cardiovascular disease (coronary artery disease [CAD] and/or stroke) was significantly more common in women with prior GDM (odds ratio 1.85) and remained significant after adjustment for race/ethnicity, age, and menopausal status (OR 1.66). Overall, cardiovascular disease was reported by 15.5% with GDM compared with 12% without, CAD by 12% vs. 11%, and stroke by 6% vs. 5%.

The CVD and CAD differences were statistically significant, but stroke was not, due to small numbers of patients, the investigators said.

Among the 890 women for whom complete data for metabolic syndrome criteria were available, a history of GDM was associated with an independent risk for CVD after adjustment for metabolic syndrome (OR 1.74) and for type 2 diabetes (OR 1.56).

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