Normoglycemia after pregnancy may not offset vascular risk of gestational diabetes
medwireNews: Research shows that women who experience gestational diabetes have an increased risk for coronary artery calcification (CAC) approximately 15 years later, even if they maintain normal glucose levels after their pregnancy.
The elevated cardiovascular disease risk among women with gestational diabetes is generally attributed to their increased risk for developing type 2 diabetes, and at a younger age, say Erica Gunderson (Kaiser Permanente Northern California, Oakland, USA) and co-researchers.
“Our findings represent a shift in this paradigm by showing that normoglycemia after a [gestational diabetes] pregnancy was still related to higher CAC risk,” they write in Circulation.
Their conclusions are based on their study of 1133 women (49% Black, 51% White) from the CARDIA study who did not have diabetes prior to their first pregnancy. These women had a total of 2066 deliveries, with 12.3% of them developing gestational diabetes.
An average of 14.7 years after their last delivery, they were assessed for CAC; this was present in 24.5% of those who had experienced gestational diabetes, compared with 15.0% of those who had not – a significant difference.
This amounted to a 66% increased risk for CAC associated with gestational diabetes after adjustment for factors including race, age at first birth, pre-pregnancy blood pressure, and smoking habits, BMI, and hypertension over time.
By the time of CAC measurement, women who had experienced gestational diabetes were also significantly more likely than those who had not to have developed type 2 diabetes, at 26% versus 9%, although rates of prediabetes were similar, at 36% and 35%, respectively.
However, the CAC risk associated with gestational diabetes appeared to be independent of later blood glucose levels; among women who maintained normoglycemia after their pregnancies, having had gestational diabetes was still associated with a significant 2.25-fold increased risk for CAC.
Moreover, the risk was not further elevated for women who developed prediabetes or type 2 diabetes after gestational diabetes, with these women having 2.11- and 1.76-fold risk increases, respectively. Prediabetes and diabetes were associated with a significantly increased CAC risk among women without gestational diabetes, however, by 1.52- and 1.82-fold, respectively.
“These findings add to the mounting evidence that enhanced cardiovascular disease risk factor screening among women with a history of gestational diabetes is needed to better risk stratify women for early atherosclerotic cardiovascular disease prevention,” the researchers conclude.
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