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GPs failing to follow women at risk after gestational diabetes

Diabetes risk 22 times higher after GDM; ischaemic heart disease and hypertension risks doubled

Louise Prime

Friday, 19 January 2018

Women with gestational diabetes (GDM) are at considerably increased long-term risk of type 2 diabetes, ischaemic heart disease and hypertension, according to UK primary care research. Yet the team behind the study*, published in PLOS Medicine, also found that despite guidelines recommending annual diabetes screening for diabetes for women who have had GDM, rates of follow-up screening were low for diabetes and most cardiovascular risk factors.

Researchers from the University of Birmingham and elsewhere conducted a retrospective cohort study using a large UK primary care database. They identified 9,118 women diagnosed with GDM between 1990 and 2016 and randomly matched them with 37,281 control women by age and timing of pregnancy (up to three months).

They then calculated adjusted incidence rate ratios (IRRs) for cardiovascular risk factors and cardiovascular disease among these women. They found that women with GDM were more likely to develop type 2 diabetes (IRR = 21.96) and hypertension (IRR = 1.85) after adjusting for age, deprivation score, body mass index, and smoking. For ischaemic heart disease (IHD), the IRR was 2.78, and for cerebrovascular disease 0.95, after adjusting for the factors already listed, and lipid-lowering medication and hypertension at baseline.

The researchers noted that women diagnosed with GDM are an identifiable group of at-risk women and ideal for targeting preventative metabolic and cardiovascular interventions. Yet they found that follow-up screening for type 2 diabetes and cardiovascular risk factors was poor (except for blood pressure), even though current guidelines recommend annual screening for diabetes in women diagnosed with GDM. Fewer than 60% of women were screened for diabetes in the first year post-partum, and rates declined rapidly thereafter. For cardiovascular risk factors such as smoking, high body mass index, hypertension, and dyslipidaemia, screening rates were far lower than for type 2 diabetes, and similar to the screening rates in control women.

The study authors concluded: “Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes."

*Daly B, Toulis KA, Thomas N, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLOS Medicine 2018; 15(1): e1002488.

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