Normoglycemia after being pregnant might not offset vascular threat of gestational diabetes


medwireNews: Research shows that women with gestational diabetes about 15 years later have an increased risk of coronary artery calcification (CAC), even if they maintain normal glucose levels after their pregnancy.

The increased risk of cardiovascular disease in women with gestational diabetes is generally attributed to their increased risk of developing type 2 diabetes, and at a younger age, according to Erica Gunderson (Kaiser Permanente, Northern California, Oakland, USA) and co-researchers.

“Our results represent a paradigm shift in that they show that normoglycemia after a [gestational diabetes] Pregnancy was still associated with a higher risk of CAC, ”they write in Circulation.

Their conclusions are based on their study of 1,133 women (49% black, 51% white) from the CARDIA study who did not have diabetes before their first pregnancy. These women had a total of 2,066 deliveries, of which 12.3% developed gestational diabetes.

An average of 14.7 years after their last delivery, they were examined for CAC; This was the case in 24.5% of the patients with gestational diabetes compared with 15.0% of the patients without gestational diabetes – a significant difference.

This represented a 66% increased risk of CAC-related gestational diabetes after adjusting for factors such as race, age at first birth, pre-pregnancy blood pressure and smoking habits, BMI, and high blood pressure over time.

At the time of the CAC measurement, women with gestational diabetes were also significantly more likely than women without gestational diabetes at 26% versus 9%, although the prediabetes rates were similar at 36% and 35%, respectively.

The CAC risk associated with gestational diabetes, however, appeared to be independent of later blood sugar levels; In women who had normoglycemia after their pregnancy, gestational diabetes was still associated with a 2.25-fold increased risk of CAC.

In addition, the risk for women who developed prediabetes or type 2 diabetes after gestational diabetes was not increased any further, with these women having a 2.11- and 1.76-fold increase in risk, respectively. Prediabetes and diabetes in women without gestational diabetes were associated with a significantly increased risk of CAC by 1.52 and 1.82 times, respectively.

“These results add to the growing evidence that improved screening of the risk factor for cardiovascular disease in women with a history of gestational diabetes is needed to better stratify women for early prevention of atherosclerotic cardiovascular disease,” conclude the researchers.

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Edition 2021; doi: 10.1161 / CIRCULATIONAHA.120.047320