medwireNews: Research shows that women with a history of gestational diabetes are at increased risk for hypertension and ischemic heart disease, as well as for type 2 diabetes.
However, follow-up screening for diabetes and vascular risk factors was poor in this real-world population, say Krishnarajah Nirantharakumar (University of Birmingham, UK) and study co-authors.
As detailed in PLOS Medicine, the team identified 9118 UK-resident women who had gestational diabetes and whose details were recorded in The Health Improvement Network (THIN) database.
Compared with 37,281 women without gestational diabetes, matched for age and timing of pregnancy, those with the complication were a significant 2.78-fold more likely to later develop ischemic heart disease, after accounting for variables including age, BMI, smoking, and hypertension.
Of note, only five of the 14 women with ischemic heart disease diagnoses had also developed type 2 diabetes, which the researchers say suggests “that the risk of cardiovascular disease is not always mediated through type 2 diabetes.”
Women with gestational diabetes also had a significant 1.85-fold increased risk for developing hypertension and, as expected, a greatly increased risk for type 2 diabetes (21.96-fold). Their risk for having a stroke or transient ischemic attack was unaffected by gestational diabetes.
New diagnoses for diabetes, hypertension, and heart disease continued to accumulate throughout follow-up, which ranged from around 1 to 25 years.
“Despite the high risk of developing type 2 diabetes and cardiovascular disease, postpartum screening was poor,” report Nirantharakumar and team.
Just 58% of women with gestational diabetes had a blood glucose measurement during the first year after their pregnancy, falling to 38% and 36% in the 2nd and 3rd years, respectively. And 24% received no glycemic testing within 3 years postpartum.
Blood pressure was better monitored during the first year, with 80% of women being tested, but this fell to 50% and 48% in the 2nd and 3rd years, respectively. Cholesterol levels were very poorly monitored, with only 11–13% of women being tested during the first 3 years after their pregnancies.
The team says the study findings “identify an at-risk group of relatively young women ideally suited for targeting of risk factor management to improve long-term metabolic and cardiovascular outcomes.”
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