Abstract P263: Gestational Diabetes and Patterns of Cardiometabolic Risk Factors Before and After Childbearing: Coronary Artery Risk Development in Young Adults Study

Abstract

Introduction: Cardiometabolic risk factor levels before pregnancy affect risk of gestational diabetes mellitus (GDM), and unfavorable risk factors have been found after pregnancy. However, changes in risk factors during both the pre- and post-childbearing periods have not been evaluated longitudinally in prospective studies. Hypothesis: Women who develop GDM pregnancy exhibit less favorable patterns of CVD risk factors during both pre- and post-childbearing eras. Methods: We used data from CARDIA, a multi-center, longitudinal cohort of black and white young adults initially aged 18-30 with serial in-person exams across 30 years (9 exams, 1985-2016). Women with ≥1 births after baseline (n=1288) self-reported GDM and were classified as “ever” GDM (n=148, at least one GDM pregnancy) and as non-GDM (all non-GDM births; n=1140). Piecewise linear mixed-models, which allowed differing intercepts and slopes for pre- and post-childbearing eras, compared GDM group to non-GDM group on annual changes in CVD risk factor (BMI, waist circumference [WC], lipids, and blood pressure) during pre-childbearing period (before the first post-baseline birth) and post-childbearing period (after the last post-baseline birth). Models adjusted for baseline socioeconomics, length of childbearing period (from the first to the last post-baseline birth), parity, time-varying lifestyle habits and medication use. Results: Annual BMI increase before initiation of childbearing was higher in GDM group than non-GDM group (0.35 vs 0.23 kg/m 2 /year; p=0.03). Similarly, WC showed marked pre-childbearing increase for GDM group compared to non-GDM group (0.82 vs. 0.54 cm/year; p=0.04). In contrast, the annual increase in BMI and WC after childbearing did not differ by GDM history. No differences were detected for the other CVD risk factors. Conclusions: Accelerated gains in overall and central adiposity before the childbearing period was associated with elevated risk of GDM, but risk factor changes do not show differences after childbearing.