Gestational Diabetes and Long-Term CVD Risk

Study Questions:

What is the association between a history of gestational diabetes (GD) and risk of major cardiovascular disease (CVD) events, including myocardial infarction (MI) and stroke?

Methods:

The investigators conducted this analysis in the NHS II (Nurses’ Health Study II), an ongoing longitudinal prospective cohort that began in 1989 with the enrollment of 116,430 female US nurses ages 24-44 years and ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. The authors included 89,479 women who reported ≥1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for >90% of eligible participants. History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years. There were 1,161 incident self-reported nonfatal or fatal MIs or strokes, confirmed via medical records. Multivariable Cox models estimated the hazard ratio (HR) and 95% confidence interval (CI) for CVD risk.

Results:

Participants had a mean (standard deviation) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index (BMI), and other covariates, GD versus no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to type 2 diabetes (T2D) in relation to CVD risk indicated a positive association for GD with progression to T2D versus no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71).

Conclusions:

The authors concluded that GD was positively associated with CVD later in life.

Perspective:

This large prospective cohort study suggests that women with a history of GD experience a modestly elevated long-term risk of CVD, although the absolute risk difference was quite low, probably related to the younger age of the cohort. Importantly, GD was not associated with CVD risk among women with healthier behavior profiles, suggesting amelioration of the risk with healthy lifestyle. Additional follow-up of these women is needed to evaluate longer-term implications of GD history on CVD risk. For now, lifestyle changes such as heart healthy diet, physical activity, maintenance of optimal BMI, and avoiding tobacco use should be recommended in women with a history of GD to mitigate future CVD risk.


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