Aortic Stiffness and Cardiovascular Risk in Women with Previous Gestational Diabetes Mellitus

Pål Aukrust,Victor Sanchez-Margalet,Tore Henriksen,Errol R. Norwitz,Tove Lekva,Thor Ueland,Jens Bollerslev

doi:10.1371/journal.pone.0136892

Pål Aukrust, Victor Sanchez-Margalet + Show 5 more

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https://doi.org/10.1371/journal.pone.0136892

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Abstract

Gestational diabetes mellitus (GDM) is a significant risk factor for cardiovascular disease (CVD) in later life, but the mechanism remains unclear. The aim of the study was to investigate indices of glucose metabolism, dyslipidemia, and arterial stiffness (as measured by pulse wave velocity (PWV)), in women with and without a history of GDM, using both the old WHO and new IADPSG diagnostic criteria, at 5 years after the index pregnancy. Dyslipidemia and PWV were used as surrogate markers for CVD risk. The population-based prospective cohort included 300 women from the original STORK study. All participants had an oral glucose tolerance test (OGTT) during pregnancy. Five years later, the OGTT was repeated along with dual-energy x-ray absorptiometry, lipid analysis, and PWV analysis. Measurements were compared between those women who did and did not have GDM based on both the WHO and IADPSG criteria. We found that women with GDM based on the old WHO criteria had higher CVD risk at 5 years than those without GDM, with markedly elevated PWV and more severe dyslipidemia (higher triglycerides (TG)/HDL cholesterol ratio). After adjusting for known risk factors, the most important predictors for elevated PWV and TG/HDL-C ratio at 5-year follow-up were maternal age, BMI, GDM, systolic blood pressure, and indices of glucose metabolism in the index pregnancy. In conclusion, we found a higher risk for CVD, based on the surrogate markers PWV and TG/HDL-C ratio, at 5-year follow-up in women diagnosed with GDM in the index pregnancy when using the old WHO diagnostic criteria.

Highlights

Gestational diabetes mellitus (GDM) refers to carbohydrate intolerance first diagnosed during pregnancy
Using the IADPSG GDM criteria, we found that GDM women had significantly decreased apoA levels and high-density lipoprotein (HDL)/low density lipoprotein (LDL)-C ratios and significantly increased TG levels and apoB/apoA and TG/HDL-C-ratios compared to non-GDM women at follow-up
In our cohort, GDM diagnosed by the WHO criteria was associated with enhanced CV risk at 5-years as determined by an increased pulse wave velocity (PWV) and TG/HDL-C ratio, we further evaluated the association between these measures and indices of glucose metabolism (i) during the index pregnancy and (ii) at follow-up

Summary

Introduction

Gestational diabetes mellitus (GDM) refers to carbohydrate intolerance first diagnosed during pregnancy. It is a condition where pancreatic beta-cells produce inadequate amounts of insulin to meet the increased insulin needs of late pregnancy [1]. In this way, pregnancy serves as a ‘stress test’ and unmasks a preexisting predisposition to carbohydrate intolerance and decreased insulin sensitivity. A diagnosis of GDM is associated with an increased risk for maternal and fetal complications during pregnancy, and with the woman’s lifetime risk of developing type 2 diabetes mellitus (T2DM). The early identification of modifiable surrogate risk markers that may predict future CVD risk is critically important for risk stratification and for the development of strategies for primary prevention, and such markers could be used to study the effect of GDM and CV risk during follow-up

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