Gestational diabetes increases T2D, hypertension, heart disease risk

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Women with gestational diabetes have a greater risk of developing T2D and cardiovascular events than women who were not previously diagnosed with the disease.
Women with gestational diabetes have a greater risk of developing T2D and cardiovascular events than women who were not previously diagnosed with the disease.

Women previously diagnosed with gestational diabetes mellitus have an extremely elevated risk of developing type 2 diabetes (T2D) and more frequent occurrences of hypertension and ischemic heart disease (IHD), according to a study published in PLoS Medicine.

Barbara Daly, RN, PhD, of the School of Nursing, Faculty of Medical and Health Sciences at the University of Auckland in New Zealand, and associates performed a retrospective group analysis using a large primary care database from the United Kingdom to examine the correlation between gestational diabetes mellitus and T2D, hypertension, and cardiovascular risks postpartum.

A total of 9118 women diagnosed with gestational diabetes mellitus were randomly matched in age and time of pregnancy to 37,281 women without gestational diabetes mellitus (control), and results were assessed for cardiovascular disease and cardiovascular risk factors.

The investigators reported that T2D was more common in women with gestational diabetes mellitus than in those without (incidence rate ratio [IRR], 21.96) after an age, smoking, and body mass index (BMI) adjustment. In addition, women diagnosed with gestational diabetes mellitus had a greater risk of hypertension (IRR, 1.85).

Using the previously stated adjustment variables, as well as lipid-decreasing medication and baseline hypertension, women with gestational diabetes mellitus had incidence rate ratios of 2.78 and 0.95 for IHD and cerebrovascular disease.

Of the women who were diagnosed with gestational diabetes mellitus, 58% were screened in their initial year postpartum for T2D in primary care.  The population of women screened after this time decreased dramatically (40% at 2 years; 24% at 3 years postpartum).

Cardiovascular risk factor screening rates were low for both groups of women. These risk factors include, but are not limited to, smoking, hypertension, and elevated BMI.

“Results showed that women diagnosed with gestational diabetes mellitus were significantly more likely to develop type 2 diabetes, hypertension, and IHD at a relatively young age compared with women without a previous diagnosis of gestational diabetes mellitus,” reported the authors.

“Follow-up screening for type 2 diabetes was poor, with less than 60% of women with gestational diabetes mellitus undergoing screening in the first year following delivery, and the proportion decreased to less than 40% by the second year,” the authors continued. “Guideline recommendations for screening and management of hypertension, lipids, and smoking cessation are lacking and need to be reviewed.”

Reference

  1. Daly B, Toulis KA, Gokhale K, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLoS Medicine. 2018 Jan 16. doi:10.1371/journal.pmed.1002488
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