Issue 161 Item 13 ADA: Gestational Diabetes Raises Cardiovascular Disease Risk L

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.