Abstract
BackgroundTo examine whether glycemic control of gestational diabetes mellitus (GDM) could modify the risk for future maternal metabolic and cardiovascular morbidities.MethodsA retrospective cohort study of women with a first diagnosis of GDM who delivered between 1991 and 2011. Women were divided into groups of good and poor glycemic control, defined as a mean daily glucose of up to 95 mg/dL (N = 230) and more than 95 mg/dL (N = 216), respectively. In addition, a control group of women without GDM (N = 352) was also analyzed. The primary outcomes were the development of type 2 diabetes mellitus (T2DM), obesity, hypertension, or dyslipidemia.ResultsMean follow-up time was 15.8 ± 5.1 years. Assessment was performed at a maternal age of 45 ± 7 years. The rates of the study outcomes in the control, GDM with good glycemic control and GDM with poor glycemic control were as follows: T2DM [19 (5.4%), 87 (38%), 127 (57%)]; hypertension [44 (13%), 42 (18%), 44 (20%)]; obesity [111 (32%), 112 (48%), 129 (58%)]; and dyslipidemia [49 (14%), 67 (29%), 106 (48%)]. Glycemic control was an independent risk factor for T2DM in multivariate Cox regression analysis (hazard ratio (HR) for poor glycemic control vs. controls 10.7 95% CI [6.0–19.0], good glycemic control vs. control HR 6.0 [3.3–10.8], and poor glycemic control vs. good glycemic control HR 1.8 [1.3–2.4]). Glycemic control was also an independent risk factor for dyslipidemia (poor glycemic control vs. controls HR 3.7 [2.3–5.8], good glycemic control vs. controls HR 2.0 [1.2–3.2], and poor glycemic control vs. good glycemic control HR 1.8 1.8 [1.3–2.6]). The fasting glucose level during oral glucose tolerance test (OGTT) was also an independent risk factor for these complications. The interaction term between glycemic control and the fasting value of the OGTT was not statistically significant, suggesting that the effect of glycemic control on the rate of future T2DM and dyslipidemia was not modified by the baseline severity of GDM.ConclusionGDM and especially poor glycemic control are associated with T2DM and dyslipidemia. Strict glycemic control for reducing that risk should be evaluated in prospective trials.
Highlights
To examine whether glycemic control of gestational diabetes mellitus (GDM) could modify the risk for future maternal metabolic and cardiovascular morbidities
GDM diagnosis was established if the 50 g glucose challenge test (GCT) was ≥ 200 mg/dL, or if the 100 g oral glucose tolerance test (OGTT) had at least two abnormal values according to the Carpenter and Coustan criteria [13], or one abnormal value according to the 1979 National Diabetes Data Group (NDDG) [14]
We found that mean daily glucose was a statistically significant predictor of type 2 diabetes mellitus (area under the curve (AUC) 62%, 95% confidence interval [56–67%])
Summary
To examine whether glycemic control of gestational diabetes mellitus (GDM) could modify the risk for future maternal metabolic and cardiovascular morbidities. The effect of glycemic control during pregnancy on other long-term maternal metabolic complication has not been elucidated It is not known whether GDM is a marker for future complications since they share a common pathogenesis or whether GDM is an independent risk factor for metabolic complications. If the latter hypothesis is true, good glycemic control may have a protective effect against future complications. Another issue of interest is examining the extent to which each complication is affected by a history of GDM, since the data in the literature is inconclusive; this, in large part, is due to heterogeneity in study designs and such confounders as ethnicity and body mass index (BMI) [11, 12]
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