Gestational diabetes (GD) can lead to an earlier onset and increased risk of type 2 diabetes, which is a risk factor for cardiovascular disease. However, it is not fully known whether reaching normoglycemia can reduce the excessive risk of cardiovascular disease associated with these patients.
A team led by Erica P. Gunderson, Research Division, Kaiser Permanente, Northern California, studied the history of gestational diabetes and post-pregnancy glucose tolerance associated with coronary artery calcification (CAC) in women who had a manifestation of atherosclerotic cardiovascular disease and represents a predictor of cardiovascular clinical events.
In the study, researchers received data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a multicenter, community-based prospective cohort of young black (50%) and white adults aged 18-30 at baseline in the United States.
A total of 1133 women without diabetes at the start of the study who had at least 1 single birth (n = 2066) during the follow-up, glucose tolerance tests at the start of the study and up to five times during 25 years (1986-2011), gestational diabetes and coronary artery measurements resulting from one or more Follow-up examinations obtained in years 15, 20 and 25 (2001-2011) were included in the final analysis.
Researchers measured coronary artery calcification using non-contrasting cardiac computed tomography that was dichotomized as CAC (score> 0) or no CAC (score = 0).
They also used complementary log-log models for interval-censored data, estimated adjusted at-risk rates from CAC, and 95% confidence intervals for gestational diabetes and subsequent glucose tolerance groups – normoglycemia, prediabetes, or incident diabetes – averaging 14.7 years after the last birth, adjusted for gestation – and follow-up covariates.
A total of 139 (12.3%) people reported gestational diabetes. The mean age of this subgroup at follow-up was 47.6 years.
Overall, CAC was present in 34 (25%) of these patients, while it was present in 149 (15%) of the women without gestational diabetes.
The adjusted risk rates were 1.54 (95% CI, 1.06-2.24) for patients without gestational diabetes / normoglycemia and 2.17 (95% CI, 1.09-4.17 for people with gestational diabetes or prediabetes and 2 , 02 (95% CI, 0.98-) 4.19) for people with gestational or prolapsed diabetes (total P = 0.003).
“Women without prior GD showed a gradual increase in CAC risk associated with deterioration in glucose tolerance,” the authors wrote. “Women with a history of GD were twice as likely to have CAC across all subsequent levels of glucose tolerance. The risk of atherosclerotic CVD in midlife in women with previous GD is not reduced by achieving normoglycemia. “
Gestational diabetes and glucose intolerance detected during pregnancy affect 250,000 women in the US, accounting for 8-9% of all pregnancies.
The study “History of Gestational Diabetes and Post-Pregnancy Glucose Tolerance Associated with Coronary Artery Calcium in Middle-Aged Women: The CARDIA Study” was published online in Circulation.