Gestational DM not only increases risk of T2DM, but also of hypertension and IHD
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 studyLiterature - Daly B, Toulis KA, Thomas N et al., - PLoS Medicine. Published: January 16, 2018
- Women diagnosed with GDM were over 20 times more likely to develop T2DM (Incidence rates ratio: IRR=21.96, 95%CI: 18.31-26.34, P<0.001). Risk of developing hypertension was almost two-fold increased (IRR: 1.85, 95%CI: 1.59-2.16, P<0.001), after adjusting for age, Townsend quintile/socio-economic status, BMI and smoking.
- After further correction for baseline lipid-lowering medication and hypertension, women with GDM showed a higher risk of developing IHD (IRR: 2.78, 95%CI: 1.37-5.66, P=0.005). The risk of cerebrovascular disease was not increased (IRR: 0.95, 95%CI: 0.51-1.77).
- Not all (5/14) women with GDM who developed IHD, also developed T2DM postpartum.
- The higher cumulative incidence of T2DM, hypertension and IHD in women with GDM compared to controls persisted throughout the 25-year study period.
- Effect sizes for T2DM, hypertension, IHD and stroke or TIA were not different in sensitivity analyses that included ethnicity in the model.
- Medical records of women with GDM documented some glycemic measurement in 58% in the first year postpartum. In the second and third year following delivery, the proportion with glycemic measurement decreased to less than 40% and 24% of women.
- Surveillance for risk factors, concerning T2DM and lipid measurements, in the postpartum period was lower in control women as compared with those with GDM, up to 3 years postpartum. Assessment of hypertension and smoking in years 2 and 3 did not differ between women with GDM and controls.
This population-based study, for the first time, reports on the increased CV risk in women diagnosed with GDM. Women with GDM are over 20 times more likely to develop T2DM and have an almost doubled risk of hypertension, and 2.8-fold higher risk of IHD, compared with control women. This increased risk persists in the long run. Despite the higher risk, postpartum screening of diabetes and CV risk was poor.