Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life‐Course Analysis in CARDIA Women

Abstract

This study hypothesized that both preconception and postchildbearing patterns of cardiometabolic risk factors may be different for women with gestational diabetes mellitus (GDM) compared with women without GDM. Methods: Among 1,302 (51% black) women in the Coronary Artery Risk Development in Young Adults (CARDIA) study with births and followed for 30 years, this study evaluated changes in cardiometabolic factors (BMI, waist circumference [WC], lipids, blood pressure) during prechildbearing (prior to the first postbaseline birth) and postchildbearing periods (after the last birth) by GDM status using piecewise linear mixed models adjusted for sociodemographics, parity, and time-varying covariates. Results: Compared with women who did not develop GDM, weight and WC increases in women who developed GDM (n = 152, 12%) were faster (BMI difference: +0.12 kg/m 2 /y, P = 0.04; WC difference: +0.28 cm/y, P = 0.04) during the prechildbearing period, accounting for covariates. This translated to an average of 1.3 kg of excess weight gain across 4 years among women with subsequent GDM versus non-GDM births. In contrast, slopes after childbearing did not differ by GDM status, nor were there other cardiometabolic differences. Conclusions: Women with GDM exhibited an increasing prepregnancy pattern of weight gain and central adiposity. Absolute postchildbearing weight was also higher in GDM-affected women, but the slope of gain after GDM was not.

Association between maternal adiposity measures and adverse maternal outcomes of pregnancy: Systematic review and meta‐analysis

“…Searches identified 24,027 studies following removal of duplicates; 945 full texts were screened for eligibility, of which 70 20,21,37–104 met the inclusion criteria (Figure S1). Of these studies, 59 were cohort and 11 were case control studies.…”

“…Fourteen studies reported associations between measures of WC and a diagnosis of GDM 46,51,55,57–60,72,77,83,86,88,97,103 and 16 reported case control data for early pregnancy WC between women diagnosed with GDM during pregnancy (cases) and women not diagnosed with GDM (controls) 37,46–48,52,57–60,67,73,78,80,83,88,103 . Nine studies reported categorical measures of WC 37,46,51,55,57,58,60,83,86,103 and eight could be pooled in the meta‐analysis (Figure 1).…”

“…Sixteen studies reported case control data and all could be included in a meta‐analysis 37,46–48,52,57–60,67,73,78,80,83,88,103 . The pooled data showed a significantly increased early pregnancy WC among women diagnosed with GDM compared with those not diagnosed with GDM (mean difference 6.18 cm, 95% CI 3.92, 8.44) (Figure 3).…”

Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

“…Women who develop GDM already have higher BMIs and worse metabolic profiles before pregnancy, which includes higher total cholesterol, triglycerides, and homeostatic model assessment for insulin resistance and lower high-density lipoprotein cholesterol [ 62 , 63 ]. Immediately after delivery, women with a previous history of GDM are more obese and have a higher prevalence of metabolic syndrome [ 64 , 65 ]. Over time after delivery, the annual increases in BMI, blood pressure, and total cholesterol did not differ between women with and without GDM.…”

“…Over time after delivery, the annual increases in BMI, blood pressure, and total cholesterol did not differ between women with and without GDM. Therefore, women with a previous history of GDM persistently have worse cardiometabolic risk factors than women without GDM over time [ 64 ]. As a result, women with a previous history of GDM have increased coronary artery calcium scores and carotid intima media thickness, which are surrogates for atherosclerosis and future CVD, after delivery [ 66 , 67 ].…”