Perspective:

Pregnancy provides a unique window to identify women with underlying predisposition to metabolic derangements or subclinical endothelial dysfunction that places them at increased risk for CVD. This study confirms the association between GDM during pregnancy and the increased risk of subsequent CVD. Importantly, this risk is not dependent on the development of type 2 diabetes and the risk is apparent within the first decade. Women with hyperglycemia during pregnancy should be informed that GDM represents a risk factor for CVD as well as diabetes, and would likely benefit from regular ongoing primary care, acknowledging that the absolute risk of CVD in young women remains low overall. Physicians should also include pregnancy-related risk factors such as GDM, as well as pre-eclampsia, when assessing CVD risk factors. The main questions that remain are: 1) what screening and follow-up would be appropriate, and 2) is there an effective intervention that would prevent the development of vascular disease in women at increased risk? While we await further research for these important questions, this study is an important first step in raising awareness of the association between GDM and subsequent CVD.