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Gestational diabetes raises long-term CVD risk

But absolute risk remains low among young women, and is lessened by healthy lifestyle

Louise Prime

Tuesday, 17 October 2017

Women who had had gestational diabetes were at higher risk of later developing cardiovascular disease (CVD) than those who had never had gestational diabetes, US research has shown. However, the absolute risk remained low in the relatively young group studied. The authors of the study*, published today in JAMA Internal Medicine, said further research is needed to evaluate longer-term health implications of a history of gestational diabetes.

Gestational diabetes is identified by the American Heart Association as a risk factor for cardiovascular disease among women based on the relationship between gestational diabetes and markers of cardiometabolic risk, but a team of US researchers wanted to see whether or not women with a history of gestational diabetes really are at an elevated risk of major CVD events later in life.

They analysed data from Nurses’ Health Study II, which began in 1989 when it enrolled more than 166,000 women aged 24 to 44 who worked as nurses. The baseline questionnaire had recorded, among other things, a history of gestational diabetes; and this was also updated every two years until 2001. The study then had records of any occurrence of fatal and nonfatal myocardial infarction or stroke, from baseline until the 2013 questionnaire.

In this particular analysis, the researchers included almost 90,000 childbearing women, of whom nearly 5,300 reported a history of gestational diabetes. During almost 26 years’ follow up, there were 612 myocardial infarctions and 553 strokes among 1,161 childbearing women.

They reported that a history of gestational diabetes was associated with a modestly increased relative risk of cardiovascular disease compared with women with no history of gestational diabetes (hazard ratio 1.43); however, the absolute risk difference was small, which they said was probably because the women in their study were young, with a mean age of just 34.9 years. They also found that women who adhered to a healthy lifestyle – eating a healthy diet, being physically active, not smoking and avoiding overweight or obesity – appear to have mitigated that risk still further, to an excess 29% risk.

They pointed out that their study was limited by its lack of racial/ethnic diversity, so they couldn’t assess the association between gestational diabetes and CVD risk in potentially higher-risk populations.

Nevertheless, they concluded: “Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.” They also called for future data, with continuous follow-up of these women, in order to evaluate longer-term health implications of a history of gestational diabetes.

* Tobias DK, Stuart JJ, Li S, et al. Association of history of gestational diabetes with long-term cardiovascular disease risk in a large prospective cohort of US women. JAMA Intern Med. Published online October 16, 2017. doi:10.1001/jamainternmed.2017.2790

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