medwireNews: The association between poor glycemic control during pregnancy and subsequent risk for cardiovascular disease (CVD) extends to women without gestational diabetes, study findings suggest.
“Accordingly, glucose screening in pregnancy could identify future risk of cardiovascular disease in women who do not have gestational diabetes,” write the researchers in The Lancet Diabetes & Endocrinology.
Ravi Retnakaran and Baiju Shah, both from Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada, analyzed data from 259,164 women with no history of diabetes who had a 1-hour oral glucose challenge test during week 24–28 of pregnancy and delivered a live infant between 2007 and 2015.
In all, 138 CVD events – hospitalization for myocardial infarction, acute coronary syndrome, stroke, coronary artery bypass grafting, percutaneous coronary intervention, or carotid endarterectomy – occurred over a median follow-up of 3.9 years, and women were aged an average of 35.8 years at the time of experiencing a CVD event.
The study authors demonstrated that each 1 mmol/L increase in plasma glucose concentration as measured by the glucose challenge test was associated with a significant 13% increased risk for developing CVD in the overall population. Event rates were approximately 10 per 100,000 person–years for individuals with glucose challenge results of 6.9 mmol/L and below, rising to approximately 12.5 and 20 per 100,000 person–years for those with results of 7.0–7.9 mmol/L and at least 8.0 mmol/L, respectively.
This association remained significant when the 13,609 women with gestational diabetes were excluded from the analysis, with each 1 mmol/L increase in glucose concentration associated with a 14% elevated CVD risk among the 245,555 women without gestational diabetes.
Therefore, “the glucose challenge test provided a continuous measure of maternal glycaemia in pregnancy that related to subsequent risk of cardiovascular disease in both the general obstetrical population and the subpopulation of women without gestational diabetes,” say Retnakaran and Shah.
They explain that according to current guidelines, gestational diabetes was diagnosed based on a plasma glucose concentration of 11.1 mmol/L or higher on the glucose challenge test, or a glucose challenge test result between 7.8 and 11.0 mmol/L followed by a positive result on a subsequent 75 g oral glucose tolerance test.
The researchers also report that among women without gestational diabetes, those with an abnormal glucose challenge test or a result in the upper end of the normal range “comprised clinically identifiable patient populations” with an elevated CVD risk.
Indeed, relative to participants with a result of 7.1 mmol/L or below, those with a result of at least 7.8 mmol/L had a significant 94% increased CVD risk, while women with a result between 7.2 and 7.7 mmol/L had a significant 65% elevated risk.
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Lancet Diabetes Endocrinol 2019; doi:10.1016/S2213-8587(19)30077-4
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