Gestational diabetes is associated with significantly increased risks of postpartum cardiovascular, kidney and metabolic (CKM) disorders, according to a retrospective cohort study published Aug. 12 in JAMA Network Open. The findings point to the need for postpartum surveillance beyond glucose screening alone.

Lili Liu, PhD, MPH, et al., analyzed Merative MarketScan data from April 1, 2007, to Oct. 12, 2023, including commercially insured women in the U.S. aged 12 to 55 years with a single delivery and no preexisting CKM disorders before delivery. Follow-up began after delivery and continued until incident diagnosis, disenrollment or the end of data availability; data were analyzed from August 2025 to March 2026.

The main outcomes were incident postpartum diagnoses of obesity, hypertension, hyperlipidemia, prediabetes, type 2 diabetes (T2D), metabolic syndrome, chronic kidney disease and cardiovascular disease. Cox proportional hazards regression models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals, and temporal patterns were assessed using postpartum interval-specific hazard ratios and year-specific incidence rate ratios.

The analysis included nearly 1.2 million women with a mean age of 28 years; 8% had gestational diabetes. Those with gestational diabetes were older than those without it (mean age 30 vs. 28 years).

Over a median follow-up of 2.4 years, women who had gestational diabetes had higher crude incidence rates per 1,000 person-years of T2D (9.9 vs. 1.0), prediabetes (12.9 vs. 2.5), hyperlipidemia (19.9 vs. 10.1), hypertension (13.9 vs. 8.1) and obesity (26.3 vs. 15.2).

In adjusted models, gestational diabetes was most strongly associated with dysglycemia, including T2D (time-averaged aHR, 10.02) and prediabetes (aHR, 5.32). Elevated risks also were observed for metabolic syndrome (aHR, 2.72), hyperlipidemia (aHR, 2.00), hypertension (aHR, 1.76) and obesity (aHR, 1.75).

Composite cardiovascular disease risk was elevated (aHR, 1.28), while chronic kidney disease risk was not (aHR, 0.96).

"These temporal patterns support postpartum care models that extend well beyond the immediate postpartum interval," write the authors, noting the importance of integrating blood pressure, lipid and weight surveillance alongside guideline-concordant glucose screening. They add that future studies with measured BMI, more diverse populations and longer follow-up are needed to refine risk estimates, explore chronic kidney disease risk and evaluate integrated postpartum prevention strategies.