Gestational diabetes doubles risk of coronary artery calcification

Women with a history of gestational diabetes (GD) are at twofold higher risk of developing coronary artery calcification (CAC), regardless of the level of glucose tolerance after pregnancy, a study has found.

The analysis used data from the Coronary Artery Risk Development in Young Adults study and included 1,133 women with normal glucose levels at baseline and had 2,066 births over 25 years of follow-up. All of them underwent glucose tolerance testing at baseline and up to five times during the study period.  

A total of 139 women (12.3 percent) reported GD during pregnancy (6.7 per 100 pregnancies). The mean age at follow-up was 47.6 years, while the mean time since the last birth to the end of follow-up was 14.7 years.

Women with previous versus no GD were more likely to develop prediabetes (36 percent vs 35 percent; p<0.001) or diabetes (25.9 percent vs 9 percent; p<0.001). Among the 125 women who developed diabetes, those with previous GD had earlier onset than those with no GD.

CAC, assessed using noncontrast cardiac computed tomography, was detected in 25 percent (34/139) of women with previous GD and 15 percent (149/994) of those with no GD.

Multivariable Cox analysis showed that the risk of CAC was high in the following groups: no GD/prediabetes (adjusted hazard ratios [aHR], 1.54, (95 percent confidence interval [CI], 1.06–2.24), no GD/incident diabetes (aHR, 2.17, 95 percent CI, 1.30–3.62), GD/normoglycaemia (aHR, 2.34, 95 percent CI, 1.34–4.09), GD/prediabetes (aHR, 2.13, 95 percent CI, 1.09–4.17), and GD/incident diabetes (aHR, 2.02, 95 percent CI, 0.98–4.19) when compared with the no GD/normoglycemia group (overall, p=0.003).

The findings underscore the importance of enhanced cardiovascular disease (CVD) risk factor screening among women with a history of GD to better risk stratify women for early atherosclerotic CVD prevention.