Abstract
Findings from previous studies examining the association between gestational diabetes mellitus (GDM) and subsequent risk of cardiovascular disease (CVD) have been inconsistent and inconclusive. We aimed to examine the associations of a previous history of GDM with risk of CVD and status of cardiovascular risk factors in a nationwide population-based study in the United States. This study included 8,127 parous women aged 20 years or older in the 2007-2014 cycles of the National Health and Nutrition Examination Survey in the United States. The exposure was self-reported diagnostic history of GDM and the outcomes were self-reported diagnostic history of CVD and measurements of cardiovascular risk factors, including blood pressure and blood lipids. Regression models with sample weights were used to examine the associations of GDM with CVD and cardiovascular risk factors. Among women with a history of both GDM and CVD, CVD was diagnosed on average 22.9 years after the diagnosis of GDM. After adjustment for demographic, socioeconomic, and lifestyle factors, a history of GDM was associated with 63% higher odds of CVD [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.02, 2.62, p-value = 0.04]. Further adjustment for body mass index (BMI) modestly attenuated the association (OR 1.52, 95% CI 0.95, 2.44, p-value = 0.08). A history of GDM was significantly associated with lower serum level of HDL-cholesterol (adjusted β-coefficient -3.33, 95% CI -5.17, -1.50, p-value ≤ 0.001), but not associated with total cholesterol, LDL-cholesterol, triglycerides, or systolic or diastolic blood pressure. Similarly, the association between a history of GDM and HDL cholesterol was attenuated after additional adjustment for BMI (adjusted β-coefficient -1.68, 95% CI -3.38, 0.03, p-value = 0.54). Women with a previous history of GDM have significantly higher risk for developing CVD and lower serum level of HDL cholesterol, compared to women without a history of GDM. The associations may be explained, at least partly, by BMI.
Highlights
Gestational diabetes mellitus (GDM), a form of glucose intolerance during pregnancy, is a common pregnancy complication affecting approximately 7% of all pregnancies in the US [1]
We identified 787 women who developed Cardiovascular disease (CVD) among 7,572 women without a history of GDM, and 42 women developed CVD among 555 women with a history of GDM
This study suggests that women with a history of GDM are at greater risk for developing CVD later in life than women without a history of GDM
Summary
Gestational diabetes mellitus (GDM), a form of glucose intolerance during pregnancy, is a common pregnancy complication affecting approximately 7% (ranging from 1 to 14%) of all pregnancies in the US [1]. Savitz et al reported that GDM was significantly associated with the risk of subsequent type 1 and type 2 diabetes, but not CVD outcomes [11]. These may be partly due to different settings (population-based vs hospitalbased), population characteristics (e.g., age, race/ethnicity) of participants, and ways of assessment of CVD (self-reports vs examination) in those studies. Findings from previous studies examining the association between gestational diabetes mellitus (GDM) and subsequent risk of cardiovascular disease (CVD) have been inconsistent and inconclusive.
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