Issue 165 Item 6 Gestational Diabetes Raises Risk of Metabolic Syndrome

Approximately 7% of pregnancies will be affected in 2003, up from 4% in 200.

Women who suffer from gestational diabetes or preeclampsia are at heightened risk of developing metabolic syndrome as soon as three years after they give birth, a new study finds.

In the prospective study of more than 100 pregnant patients, about 30% of those who suffered preeclampsia or gestational diabetes during pregnancy developed metabolic syndrome within 36 months compared with only 5% of women who were healthy throughout their pregnancy.

"This is very serious in terms of cardiovascular disease risk," said Zsolt Bosnyak, MD, who led the study while a postdoctoral fellow at the University of Pittsburgh Graduate School of Public Health in Pennsylvania.

"A history of pregnancy-induced disturbances should be viewed as a potential marker for increased risk of heart disease, with women monitored and counseled accordingly," said Dr. Bosnyak, who is now a clinician at the National Centre for Diabetes Care in Budapest, Hungary.

Laurence Kennedy, MD, FRCP, professor of medicine and chair of the Division of Endocrinology at the University of Florida in Gainesville, agreed.

"Quite a lot of these women do not understand that there will be long-term consequences," said Dr. Kennedy, who was not involved with the trial. "They need to be taught to pay special attention to symptoms and how to modify their diet and exercise habits."

During a poster session at the American Diabetes Association’s 63rd Scientific Sessions here, Dr. Bosnyak said he undertook the research to assess the impact of skyrocketing rates of gestational diabetes in the U.S. Approximately 7% of pregnancies will be affected in 2003, up from 4% in 2001, he said.

Also, previous studies on the long-term consequences of high blood pressure and diabetes during pregnancy have shown conflicting results, he noted.

Known as the Post Partum Insulin Resistance and Cardiovascular Risk Study, the current trial enrolled and followed the health status of 36 women with preeclampsia, 33 women with gestational hypertension, 24 with gestational diabetes, and 31 healthy pregnant women matched for age, sex, and prepregnancy body mass index.
By three years’ follow-up, women with gestational diabetes were 12.5% more likely than controls to suffer from hypertension, 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.

Triglyceride levels were 127 mg/dL in the gestational diabetes group compared with 118 mg/dL in the controls.

Also, 54.2% of women in the gestational diabetes group developed insulin resistance compared with 41.7% of those in the preeclampsia group and 16.1% of controls.

Those with gestational diabetes also had higher glucose levels: 100 mg/dL vs. 87 mg/dL in the control group. Serum insulin levels were also higher: 24.6 U/mL vs. 14.5 U/mL in controls.

The study used the World Health Organization definition of metabolic syndrome: Elevated insulin levels or fasting blood glucose levels of 101 mg/dL to 109 mg/dL, along with two or more of the following: abdominal obesity, dyslipidemia, and hypertension.

ADA 63rd Scientific Sessions: Abstract 1763. Presented June 14, 2003.
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