Abstract
BackgroundGestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease.Methods and findingsWe conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31–26.34) and hypertension (IRR = 1.85; 95% CI 1.59–2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37–5.66), and for cerebrovascular disease 0.95 (95% CI 0.51–1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease.ConclusionsWomen diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.
Highlights
Gestational diabetes mellitus (GDM) is increasing, largely due to the obesity epidemic [1] and increasing maternal age [2]
Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and ischemic heart disease (IHD)
The National Institute for Health and Care Excellence guidelines recommend annual screening for type 2 diabetes in women diagnosed with GDM, this study found that follow-up screening was poor for type 2 diabetes and other cardiovascular risk factors such as hypertension
Summary
Gestational diabetes mellitus (GDM) is increasing, largely due to the obesity epidemic [1] and increasing maternal age [2]. The association between GDM and type 2 diabetes is well established [15,16], onset of the latter following delivery is less well documented and understood in terms of underlying genetic and lifestyle factors [16]. 3 previous large population-based studies quantifying the increased risk of cardiovascular disease following delivery in women diagnosed with GDM were identified [17,18,19]. Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease
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