ADA: Gestational Diabetes Raises
Cardiovascular Disease Risk Later in Life
Women who develop gestational diabetes
or preeclampsia are more likely to develop insulin
resistance and metabolic syndrome later in life
than other pregnant women, a new study finds.
Zsolt Bosnyak, MD, who led the study while he
was a post-doctoral fellow at University of Pittsburgh
Graduate School of Public Health, in Pittsburgh,
Pennsylvania, presented the findings at the American
Diabetes Association's 63rd Scientific Sessions.
He is now a clinician at National Centre for Diabetes
Care, in Budapest, Hungary.
Dr. Bosnyak said he undertook the research because
previous studies have shown conflicting results
on the long-term consequences of high blood pressure
and diabetes during pregnancy. Gestational diabetes
is on the rise, with an 7% of pregnancies in the
United States estimated to be affected in 2003,
up from 4% in 1998, he said.
The Post Partum Insulin Resistance and Cardiovascular
Risk Study enrolled and followed prospectively
the health status of 36 women with preeclampsia,
33 women with gestational hypertension, 24 with
gestational diabetes and 31 controls matched for
age, sex and body-mass index.
Within 1 to 3 years of delivery, women with preeclampsia
or gestational diabetes had a significantly increased
risk of becoming insulin resistant compared with
control subjects.
After 3 years, 54.2% of women in the gestational
diabetes group had insulin resistance, compared
with 41.7% of those in the preeclampsia group
and 16.1% of controls. Also, women with gestational
diabetes developed higher glucose levels than
the other women. At 3 years, levels were 100 mg/dL
versus 87 mg/dL in the control group. Also, serum
insulin levels were higher: 24.6 U/mL versus 14.5
U/mL in controls.
Women with gestational diabetes were also 12.5%
more likely than controls to develop hypertension
by 3-years post-delivery, the study showed. Women
with preeclampsia or gestational hypertension
were 25% more likely than the control group to
develop high blood pressure in the follow-up period.
Most importantly, Dr. Bosnyak said, about 30%
of women in both the preeclampsia and gestational
diabetes groups had metabolic syndrome at 3 years
follow-up, compared with 5% of controls.
He said he used the World Health Organization
definition of metabolic syndrome, which involves
elevated insulin levels or a fasting blood glucose
of 101 to 109 mg/dL, along with two or more of
the following: abdominal obesity, dyslipidemia
and hypertension.
"This is very serious," Dr. Bosnyak
said in an interview. "A history of pregnancy-induced
disturbances should be viewed as a potential marker
for increased cardiovascular disease risk, with
such women monitored and counseled accordingly,"
he said.
[Study title: Post Partum Insulin Resistance
and Cardiovascular (CV) Risk in Women with Pregnancy
Induced Disturbances. Abstract 1763-P]
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FACT:
In a national study, patients who lost a mere
7 percent of their total body weight reduced their
risk for diabetes by 58 percent. A study in Finland
found the same benefit with only a 5 percent weight
loss. Similar improvements have been documented
for hypertension and even sleep apnea.
