Gestational Diabetes Alone Linked to Later-Life Coronary heart Illness

Poor blood sugar control during pregnancy has been linked to poorer heart health in women in the future, researchers reported.

In a study of over 1,100 women, those with previous gestational diabetes had a more than two-fold increased risk of later coronary artery calcification, regardless of glucose levels, reported Erica Gunderson, PhD, MS, MPH, of Kaiser Permanente in Oakland, Calif. And colleagues .

Even if women maintained normal glucose levels after a pregnancy in which they had gestational diabetes, decades later they carried an increased heart risk compared to women without a history of gestational diabetes:

• Normoglycemia after pregnancy: adjusted hazard ratio [aHR] 2.34 (95% CI 1.34-4.09)
• Post-pregnancy prediabetes: aHR 2.13 (95% CI 1.09-4.17)
• Post-pregnancy diabetes: aHR 2.02 (95% CI 0.98-4.19)

As expected, women who didn’t have gestational diabetes but had high blood sugar levels in the years after pregnancy were also at a higher risk of coronary artery calcification. Women with prediabetes in particular saw a 54% increased risk (aHR 1.54, 95% CI 1.06-2.24), while women who developed type 2 diabetes saw a more than two-fold increased risk (aHR 2 , 17.95% CI 1.30-3.62). .

“We were surprised to discover that women with a history of gestational diabetes have a significantly higher risk of heart artery calcification even if they maintain normal blood sugar levels after pregnancy,” Gunderson said in a statement.

“Heart disease risk assessment shouldn’t wait for a woman to develop prediabetes or type 2 diabetes,” she recommended. “Diabetes and other health problems that develop during pregnancy herald the future risk of chronic diseases, particularly heart disease.”

She noted that “health systems must include a history of gestational diabetes in health records and periodically monitor the risk factors for heart disease and the recommended tests for type 2 diabetes in these women, which is critical to the goal.” ” Prevention efforts. “

These results are reflected in the 2018 Cholesterol Clinical Practice Guidelines of 10 medical organizations, including the American Diabetes Association and the American Heart Association, which highlight gestational diabetes as a risk factor for risk of atherosclerotic cardiovascular disease.

“After pregnancy and throughout the life of every woman, a thorough pregnancy history should be established and risk factors and risk-exacerbating factors identified,” says the guideline, which suggests possible interventions including lifestyle counseling and statin therapy.

The analysis was based on data from the US-based CARDIA (Coronary Artery Risk Development in Young Adults) study and included 1,133 women (50% black, ages 18-30) who were free of diabetes at baseline and over 25 years of age had one or more single births after follow-up.

Gestational diabetes was defined as a report of diabetes only during pregnancy, meaning there was no pre-pregnancy diabetes diagnosed from the 3-hour 100g oral glucose tolerance test results.

Of women with gestational diabetes, 62% developed diabetes or prediabetes in the years after giving birth. Only 44% of those who never developed gestational diabetes later developed elevated glucose levels.

During the follow-up examination, 16.2% of women developed calcification of the coronary arteries (score> 0). While only 15% of women without gestational diabetes developed coronary plaque, a quarter of those who previously had gestational diabetes did.

Gunderson’s group found that a history of gestational diabetes “may represent a constellation of risk factors,” such as dyslipidemia, rising blood pressure, increasing insulin resistance, endothelial dysfunction, and inflammatory responses, which in the absence of which could lead to the development of coronary plaque from hyperglycemia.

• Kristen Monaco is a contributor focused on endocrinology, psychiatry, and dermatology news. She is based in New York City and has been with the company for nearly five years.

Disclosure

The study was supported by grants from the National Institute for Diabetes and Digestive and Kidney Diseases.

Gunderson and co-authors reported a relationship with Janssen Pharmaceuticals Inc. No further information was provided.