Gestational diabetes vascular risk not solely down to type 2 diabetes development
medwireNews: Women with gestational diabetes have a subsequent increased risk for adverse macrovascular outcomes, even if they never develop type 2 diabetes, report researchers.
“As would be expected in a population of young women of childbearing age observed for median period of 10.0 years, the absolute incidence of the vascular outcomes is not very high,” say Ravi Retnakaran and Baiju Shah, both from the University of Toronto in Ontario, Canada.
Among the 1,515,079 women in the study, identified in healthcare administrative databases, the rate of cardiovascular disease (CVD) outcomes ranged from 25.9 per 100,000 person–years in those who developed neither gestational diabetes nor type 2 diabetes to 88.7 per 100,000 person–years in those who developed both. Most events occurred around 10 years after pregnancy, when the women were in their 40s.
“However, the clinical importance of these data relates to the implications for vascular risk assessment,” the team writes in Diabetes Care.
Even in the absence of type 2 diabetes, women who developed gestational diabetes were 1.30-fold more likely to have a CVD outcome, relative to those who did not, after accounting for age, income, and area of residence.
The researchers suggest that women who previously had gestational diabetes “may benefit from earlier cardiovascular risk factor assessment,” although they caution that the benefits of early screening and risk factor modification remain to be proven in these women.
However, they observe that “this early presentation of enhanced macrovascular risk suggests that the long-term benefit of risk factor modification may be particularly great in this patient population (one that had not been previously recognized as being at elevated risk, in contrast with individuals with diabetes).”
The presence of type 2 diabetes increased risk for CVD, being associated with a 2.01-fold increased risk in isolation and a 2.82-fold increased risk in combination with gestational diabetes.
The researchers say that their large study, with extended follow-up, shows that the CVD risk associated with gestational diabetes is not driven purely by the increased risk for later type 2 diabetes – rather, type 2 diabetes amplifies an already elevated risk.
Retnakaran and Shah also looked at microvascular outcomes, but found that women with gestational diabetes alone did not have an increased risk for retinopathy procedures, dialysis initiation, or hospitalization for foot infection. The likelihood of these outcomes increased only in women who developed type 2 diabetes but most strikingly in those who also had gestational diabetes.
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