medwireNews: Women with a history of gestational diabetes have a significantly increased risk for cardiovascular disease (CVD), which may be modified by healthy lifestyle factors, prospective study data show.
Cuilin Zhang (National Institutes of Health, Rockville, Maryland, USA) and co-investigators found that, among 89,479 participants of the Nurses’ Health Study II who reported at least one pregnancy and were free from CVD and cancer at baseline, 5292 (5.9%) had a history of gestational diabetes.
Of these, 82 subsequently developed CVD during a median follow-up period of 25.7 years. This compared with 1079 CVD events in the 84,187 women with no history of gestational diabetes and corresponded to incidence rates of 1.37 and 1.10 cases per 1000 person–years, respectively.
After adjustment for age, prepregnancy BMI and other potential confounders, gestational diabetes was associated with a significant 43% increased risk for subsequent CVD.
However, when the researchers also took weight gain since pregnancy, current smoking status, diet quality score, alcohol intake, aspirin use, and physical activity into account, they found the risk increase was reduced to 29%.
The greatest risk for CVD occurred among the 1008 (19%) women with gestational diabetes who subsequently developed type 2 diabetes. These women had a significant fourfold increased risk for CVD, compared with women with no gestational or type 2 diabetes, whereas women with gestational diabetes only had nonsignificant 1.3-fold increased risk.
The researchers also found that stratifying the women by healthy behavior after pregnancy “suggested maintaining a healthier lifestyle in midlife may attenuate the association between a history of gestational diabetes and CVD risk.”
Specifically, women with a diet quality score above the median value, those with at least 500 metabolic equivalent task-minutes per week of physical activity, never smokers, or those with a BMI below 25.0 kg/m2 all had attenuated risks for CVD.
Writing in JAMA Internal Medicine, Zhang and co-authors conclude: “Together, our findings suggest [gestational diabetes] is possibly related to CVD risk through a sustained unhealthy lifestyle after pregnancy.”
They add that their data “support the role of lifestyle for the prevention of CVD among high-risk women with a history of [gestational diabetes], although the small absolute rate increase of approximately 0.3 CVD events per 1000 person-years observed for those with a history of [gestational diabetes] among these younger, predominantly white women may preclude widespread costly long-term interventions.”
“Future data with continuous follow-up of these women are warranted to evaluate longer-term health implications of [gestational diabetes] history,” they write.
By Laura Cowen
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