Gestational Diabetes May Increase the Risk For Early Heart Disease

Gestational diabetes appeared as an independent risk factor for heart disease whether or not the women went on to develop diabetes or metabolic syndrome.

Women with gestational diabetes may have an increased risk for early development of heart disease after pregnancy even without the onset of diabetes or the metabolic syndrome,1 according to a 20-year follow up study published in the Journal of the American Heart AssociationPregnant woman having her blood sugar tested

“Our research shows that just having a history of gestational diabetes elevates a woman’s risk of developing early atherosclerosis before she develops type 2 diabetes or metabolic syndrome,” said lead author Erica P. Gunderson, PhD, MPH, a senior research scientist in the Kaiser Permanente Northern California, Division of Research in Oakland, California.

“Pregnancy has been under-recognized as an important time period that can signal a woman’s greater risk for future heart disease. This signal is revealed by gestational diabetes,” Dr. Gunderson told EndocrineWeb.

“We need a shift in thinking about how to identify a subgroup at risk for atherosclerosis early. The concept that reproductive complications unmask future disease risk is a more recent focus. It may inform early prevention efforts,” she said.

Longitudinal Study Examined Cardiac Risk in Young Women
The researchers used data from 898 women (47% African American; age 18 to 30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study.1 The women did not have diabetes or heart disease at baseline (1985-1986) and have at least one birth after the study began. Overall, 119 of the 898 women developed gestational diabetes.

Measurements of common carotid intima media thickness (ccIMT) were used to assess early signs of atherosclerosis in all of the participants between 2005 and 2006—an average of 12 years after pregnancy; the women were 38 to 50 years old.1

Factors Predictive of Heart Disease Identified 

In the overall group, mean ccIMT was not significantly higher in women with a history of gestational diabetes than in those without this disorder after adjusting for prepregnancy body mass index (BMI).1

However, among women who did not develop diabetes or metabolic syndrome during the follow up period, women with a history of gestational diabetes had a 0.023 mm larger average ccIMT compared to those who did not develop gestational diabetes (0.784 mm versus 0.761 mm, = 0.039), after controlling for race, age, parity, and prepregnancy BMI.1 

This difference represents a 3- to 5-year increase in vascular aging. The presence of insulin resistance before pregnancy with evidence of high blood pressure at follow-up two decades later modestly attenuated the association of gestational diabetes on ccIMT in this subgroup.1

“In contrast, among women who had developed diabetes or the metabolic syndrome after pregnancy, average ccIMT did not differ by history of gestational diabetes,” Dr. Gunderson said.

“Weight gain and blood pressure elevations after pregnancy in women with gestational diabetes were responsible for the greater carotid artery wall thickness,” Dr. Gunderson said.

Interpreting the Findings for Clinical Relevance

“The authors found that women with gestational diabetes had a greater ccIMT than those without gestational diabetes. I think the main clinical message is that we should think of gestational diabetes as a marker of a woman who is at increased risk for metabolic and cardiovascular problems in her future,”  Baiju Shah MD, PhD, associate professor of medicine at the University of Toronto, Canada told EndocrineWeb. Dr. Shay was not involved in the study but agreed to discuss the study outcomes.

Dr. Shah called for “further research into behavioral interventions for women with prior gestational diabetes to maintain a healthy weight, diet, and physical activity levels, to see whether these can lead to improvements in cardiometabolic health for these women.”

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