973: Long-term maternal metabolic and cardiovascular phenotypes after pregnancies complicated by mild GDM

Abstract

To evaluate the association of mild GDM and/or obesity on long-term maternal metabolic and cardiovascular markers. Secondary analysis of 5-10 year follow-up from a mild GDM study that included a treatment trial for mild GDM and an observational cohort of women with abnormal 1-hour GCT only. Women who had maternal 1-hour glucose tolerance tests at the follow-up were included. Maternal serum was analyzed using magnetic bead-based multiplex assays to measure insulin levels and cardiovascular markers VEGF, VCAM-1, CD40L, GDF-15, and ST-2. Insulin levels were used to calculate the insulinogenic index (IGI), a measure of pancreatic ß-cell function, and 1/HOMA, a measure of insulin resistance. These markers were compared by parent study GDM status (treated GDM, untreated GDM, and non-GDM) and by obesity at parent study enrollment. Multivariable linear regression estimated the association of GDM status and obesity with the metabolic and cardiovascular markers, adjusting for age, race/ethnicity and years since index pregnancy. 642 women with serum samples available for testing were included in this analysis (Table). Treated GDM and untreated GDM were associated with lower mean differences in log 1/HOMA, compared with non-GDM (-0.24, 95%CI -0.36–-0.12 and -0.15, 95%CI -0.28–-0.03, respectively, Figure). Treated GDM was also associated with lower mean difference in log VCAM (-0.11, 95%CI -0.19–-0.03). GDM status was not associated with IGI or other cardiovascular markers. Obesity was only associated with lower mean difference in log 1/HOMA (-0.42, 95%CI -0.52–-0.32). Women with mild GDM and obese pregnant women are at increased risk for insulin resistance at long term follow-up. Among this population, neither GDM nor obesity was associated with pancreatic ß-cell dysfunction. Treatment of mild GDM may be associated with less angiogenesis, but neither mild GDM nor obesity was associated with other markers of cardiovascular dysfunction 5-10 years after pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)