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Gestational Diabetes Issues Portend CV Risk

Hypertensive disorders in pregnancy and gestational diabetes are associated with a greater predicted risk of future cardiovascular disease.

According to Abigail Fraser, PhD, MPH, of the University of Bristol in England, and colleagues, preeclampsia and gestational hypertension were both associated with roughly 30% higher odds of cardiovascular disease as predicted by the Framingham risk score (ORs 1.31 and 1.27, respectively).

A similar association was observed for gestational diabetes (OR 1.26), but not for other pregnancy complications, including giving birth to babies who are small or large for their gestational age and preterm delivery, the researchers reported.

Abigail Fraser in an interview said, “What our study suggests is that perhaps it would be a good thing for doctors to know about women at the point of care — whether they had any of these pregnancy-related complications — because the complications means that these women are at an increased risk of cardiovascular disease and something could be done about it.”

The findings join those from an increasing number of studies pointing to a relationship between pregnancy complications and elevated cardiovascular risk. What is unique about the current study, however, is that the women were followed prospectively from pregnancy into middle age, which provided detailed information that might help identify mechanisms.

They examined data on roughly 3,400 women with a singleton birth who participated in the Avon (U.K.) Longitudinal Study of Parents and Children (ALSPAC). Follow-up lasted an average of 18 years, when the average age of the women was 48.

The pregnancy complications examined were pregnancy diabetes (pregestational diabetes, gestational diabetes, and glycosuria), hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), preterm delivery (before 37 weeks gestation), and size for gestational age.

Overall, 35.8% of the women had at least one pregnancy-related complication — 29.8% had one, 5.2% had two, 0.8% had three, and one woman had all four.

During follow-up, 1.3% of the women were diagnosed with cardiovascular disease. At the follow-up assessment, the median 10-year Framingham risk of cardiovascular disease was 3%. The risk was expected to be low because of the relatively young age of the cohort, the researchers noted.

After accounting for various confounders, the following relationships between pregnancy complications and cardiovascular risk factors were identified:

  • Pregestational diabetes, gestational diabetes, and glycosuria were associated with increased fasting glucose, and gestational diabetes and glycosuria were associated with higher insulin and proinsulin levels.
  • The hypertensive disorders of pregnancy were associated with increases in body mass index, waist circumference, systolic and diastolic blood pressure, and insulin, and lower levels of HDL cholesterol.
  • Having a baby who was large for gestational age was associated with increased waist circumference and fasting glucose, and having a baby who was small for gestational age was associated with higher blood pressure.
  • Preterm birth was associated with higher blood pressure.

The finding that preeclampsia is related to a greater number of cardiovascular risk factors compared with gestational diabetes suggests that preeclampsia may be a better predictor of future cardiovascular disease, Fraser said, although she cautioned that further replication in other populations is needed.

Practice Pearls:
  • A similar association was observed for gestational diabetes, including giving birth to babies who are small or large for their gestational age and preterm delivery.
  • Preeclampsia, gestational hypertension, and gestational diabetes are associated with a greater predicted risk of future cardiovascular disease.

Fraser A, et al “Associations of pregnancy complications with calculated CVD risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children” Circulation 2012; DOI: 10.1161/‚ÄčCIRCULATIONAHA.111.044784.