Abstract 034: Gestational Diabetes Mellitus Pregnancy is Associated with Subsequent Atherosclerosis in Women During Midlife: CARDIA.

Abstract

Background: Women who develop gestational diabetes mellitus (GDM) during pregnancy have a 7-fold greater risk of type 2 diabetes and 2.5-times greater risk of the metabolic syndrome several years after delivery than women without a history of GDM. Yet, little is known about whether GDM status contributes to early subclinical atherosclerosis after pregnancy. We hypothesize that a history of GDM is a predictor of early atherosclerosis in women during mid-life. Methods: We examined 883 women (47% Black), aged 18-30 years at enrollment in 1985-1986 (baseline) in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Women selected for this analysis delivered 1 or more live births (total of 1,572 births) during the 20-year follow-up, reported GDM status for pregnancies, had no history of heart disease, and had common carotid intima media thickness (maximum ccIMT; average of the maximum wall thickness of the respective carotid artery segment based on 4 ultrasonic measurements for the common carotid arteries) obtained after 20 years of follow-up in 2005–2006. Results: We classified 121 (14%) women as GDM, and 762 women as non-GDM. Among GDM and non-GDM groups, average age at last birth was 31 years, and average age at the year 20 exam was 44 years. Multivariable linear regression models estimated mean (95%CI) ccIMT (mm) among GDM and non-GDM groups adjusted for baseline parity and follow-up covariates including number of post-baseline births, smoking, education, hypertension status, lipid-lowering medication use, and menopausal status. Unadjusted and fully adjusted mean ccIMT was higher for GDM versus non-GDM groups: (0.791 vs 0.758; p=0.002), and (0.813 vs 0.787;p=0.011), respectively. Adjustment for baseline BMI (a mediator of both GDM and IMT), modestly attenuated the difference in ccIMT means between GDM (0.799) and non-GDM (0.781); p=0.084. Race and age did not act as confounders or as effect modifiers of associations, and BMI was not an effect modifier. Addition of weight gain, and pregnancy-related hypertension during 20 years of follow-up in separate models had little impact on these findings. Conclusions: Among women of reproductive age, GDM during pregnancy may unmask future risk of subclinical atherosclerosis during midlife. Development of GDM during pregnancy serves as an important harbinger of future cardiometabolic diseases in young women long before disease onset.