Tuesday , November 21 2017
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Gestational Diabetes and the Risk of Heart Disease

According to research by the American Heart Association, pregnant women who develop gestational diabetes may be at an increased risk of developing atherosclerotic complications, such as heart disease, later in life…. 

In this 20-year study, researchers assessed whether gestational diabetes increased the risk of early atherosclerosis in a fashion independent of pre-pregnancy obesity and subsequent metabolic disease. This study examined 898 women, between the ages of 18 to 30-years, each having no evidence of heart disease or diabetes prior to the study. Researchers used multivariable linear regression to look for associations between gestational diabetes and common carotid intima-media thickness (ccIMT) before and after pregnancy. These associations were adjusted for age, race, parity, and also for pre‐pregnancy cardio-metabolic risk factors.

Of the 898 women studied, approximately 13% went on to develop gestational diabetes. In the 777 participants who did not have subsequent diabetes the average ccIMT was 0.023mm higher for those who had gestational diabetes compared to those who did not have gestational diabetes. The author noted that this difference was not attributed to obesity or elevated glucose before pregnancy.

According to Dr. Erica Gunderson, Ph.D., the lead author of this study, "Just having a history of gestational diabetes may elevate the [patient’s] risk of developing early, sub-clinical atherosclerosis before she develops type 2 diabetes or the metabolic syndrome." The author points out that "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, a condition of elevated blood sugar during pregnancy."

Practice Pearls:
  • Although gestational diabetes usually resolves following pregnancy it is a risk factor for future complications such as diabetes
  • Having a history of gestational diabetes may be a significant risk factor for early subclinical atherosclerosis in women before the onset of diabetes and metabolic diseases
  • Early postpartum screenings may result in earlier detection of diabetes and atherosclerotic complications, and faster time to treatment

Gunderson EP, Chiang V, Pletcher MJ, et al. History of Gestational Diabetes Mellitus and Future Risk of Atherosclerosis in Mid-life: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc. 2014;3(2):e000490.