Women with gestational diabetes at risk of a wider range of CVD than thought

While gestational diabetes is known to be associated with an increased risk of cardiovascular (CV) disease later in life, the extent of CV risk has only come to light in a study presented at the 2022 SMFM Annual Meeting.  

“Gestational diabetes is associated with an increased risk of more diverse CV outcomes than previously [thought], and conventional risk factors such as subsequent diabetes, hypertension, and dyslipidaemia partially contributed to this relationship,” said lead author Dr Lee Seung Mi from Seoul National University College of Medicine in Seoul, South Korea.

In the prospective cohort study, 219,330 female participants from the UK Biobank who reported ≥1 live birth were followed on incidence of CV outcomes and the analysis was stratified based on history of gestational diabetes. Among these, 13,094 women (6.0 percent) had developed incident CV outcomes overall during follow-up. [SMFM 2022, abstract 53]

Compared with women without a history of gestational diabetes, those with prior gestational diabetes were significantly more likely to develop incident CV outcomes overall (rates, 7.80 vs 5.81 per 1,000 women-year; p<0.001). The corresponding hazard ratio (HR) for total CV outcomes was 1.365 (p<0.001) in women with vs without prior gestational diabetes, after controlling for multiple confounding variables.

Specifically, the risk of mitral regurgitation (HR, 2.276; p<0.001), myocardial infarction (HR, 1.678; p<0.001), and ischaemic stroke (HR, 1.696; p=0.004) was significantly higher in women with a history of gestational diabetes than those without, after adjusting for potential confounding factors.

In addition, the risk of atrial fibrillation/flutter (HR, 1.474; p<0.001), heart failure (HR, 1.426; p=0.013), coronary artery disease (HR, 1.330; p=0.003), and peripheral artery disease (HR, 1.064; p=0.007) were similarly increased in women with prior gestational diabetes compared with those who did not.

On the other hand, there were no significant associations seen between gestational diabetes and aortic stenosis (HR, 0.8448; p=0.689) or venous thromboembolism (HR, 1.064; p=0.699).

“We’ve known that gestational diabetes can lead to heart problems,” said Lee. “This research shows us the extent of heart health problems that can arise long after someone has given birth.”

Not only was gestational diabetes associated with excess risk of a wide range of CV outcomes, the researchers also found that the risk increased with age.

Using mediation analyses, the researchers showed that subsequent overt diabetes could only explain 23 percent of the CV incidence, while hypertension and dyslipidaemia accounted for 11 percent and 10 percent, respectively, of the association between gestational diabetes and overall CV outcomes.

“The next step is to look at what kind of preventative measures can be taken during pregnancy to hopefully prevent cardiovascular disease from developing later in life,” suggested Lee.