Abstract
BackgroundWomen with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT.MethodsThis is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity.ResultscIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P < 0.05) except for the right common carotid. The pGDM women showed similar cIMT measurements to MS in all sites of measurements, except for the left carotid bifurcation, where it was significantly higher than MS (P < 0.001). In a multivariate analysis which included classical cardiovascular risk factors and was adjusted for confounders, pGDM was shown to be independently associated with increased composite cIMT (P < 0.01). The pGDM without risk factors further showed similar cIMT to MS (P > 0.05) and an increased cIMT when compared to controls (P < 0.05).ConclusionsPrevious GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.
Highlights
Women with previous gestational diabetes mellitus face a higher risk of developing type 2 diabetes and, a higher cardiovascular risk
There were no significant differences in age among groups (P > 0.05) Patients from previous gestational diabetes mellitus (pGDM) and metabolic syndrome (MS) groups showed significantly higher body mass index (BMI) and waist when compared to Control group (CG) (P < 0.001 for both comparisons)
Systolic and diastolic blood pressures, fasting glucose, total cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides were higher in pGDM and MS when compared to controls (P < 0.001 for all comparisons) whereas high-density lipoprotein cholesterol (HDLc) from these two groups was lower than CG (P < 0.001for both comparisons)
Summary
Women with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT. Gestational diabetes mellitus (GDM) is a carbohydrate intolerance detected during pregnancy and its prevalence rate varies between 1-14% [1]. Carotid intima-media thickness (cIMT) measured by ultrasound is an inexpensive test to assess the presence of subclinical atherosclerosis. It assesses the atherosclerotic disease process itself, which includes the net effect of hereditary and environmental factors, either known or yet to be discovered [6]. CIMT has been considered an independent predictor of future cardiovascular events such as stroke and coronary artery disease, and it has been used as a surrogate end point in many clinical trials and epidemiological studies [7]
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