Oxidized LDL, insulin resistance and central blood pressure after gestational diabetes mellitus.

Abstract

Gestational diabetes mellitus (GDM) is an indicator of future cardiovascular disease. We investigated whether sensitive biomarkers of increased cardiovascular risk differ between women with and without a history of GDM few years after pregnancy, and whether obesity affects the results. We studied two cohorts - 120 women with a history of GDM and 120 controls, on average 3.7years after delivery. Circulating concentrations of oxidized low-density lipoprotein (oxLDL) were determined by ELISA. The homeostasis model assessment of insulin resistance (HOMA-IR) index was used to estimate insulin resistance. Central blood pressure (cBP) was measured noninvasively from a radial artery pulse wave. The primary outcomes were possible differences in oxLDL, HOMA-IR or cBP between thegroups. Secondly, we investigated the influence of obesity on the results, also using adjusted multiple linear regression analyses. OxLDL concentrations or cBP did not differ between the two cohorts, but HOMA-IR wassignificantly higher in women with previous GDM than in controls, 1.3±0.9 (SD) and 1.1±0.9, respectively (p=0.022). In subgroup analyses, HOMA-IR (p<0.001), systolic (p<0.001) and diastolic (p<0.001) cBP were significantly higher in obese subgroups compared with non-obese ones. Body mass index was an important determinant of HOMA-IR and cBP in multiple linear regression analyses. Over 3years after delivery, women with GDM were still more insulin-resistant than controls. Obesity turned out to be a more important determinant of insulin resistance and cBP compared with GDM.