Evaluation of postpartum carbohydrate intolerance and cardiovascular risk factors in women with gestational diabetes

Abstract

We aimed to evaluate the predictors of subsequent development of postpartum carbohydrate intolerance, metabolic syndrome and cardiovascular risk factors in women with previous GDM. Two hundred fifty-two consecutive women with GDM were enrolled. After exclusion of women who did not attend to the hospital for follow-up visits for minimum 1 year, data of 195 patients were evaluated. Seventy-one lean women with negative screening for GDM were included as a control group. The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose and metabolic syndrome was significantly higher in women with previous GDM than healthy controls. Women with previous GDM were more insulin resistant, had an atherogenic lipid profile and increased carotid IMT. The most important predictors of postpartum diabetes were the need for insulin treatment during index pregnancy and glucose values on antepartum OGTT. Among women with previous GDM, the development of postpartum diabetes and metabolic syndrome was associated with increased carotid IMT. Our data show that women with previous GDM are at high risk for developing carbohydrate intolerance, metabolic syndrome and atherosclerosis. Antepartum prediction of high risk subjects for the subsequent development of postpartum carbohydrate intolerance and metabolic syndrome seems to be vital to prevent cardiovascular outcomes.

Review of gestational diabetes mellitus effects on vascular structure and function

“…20,21 Three studies created subgroups for women with previous GDM based on BMI; 7,9,12 two studies created subgroups based on glycaemic levels. 8,14 Finally, four studies matched subjects on age alone, 14,[16][17][18] while Hannemann et al 10 matched subjects on age, as well as BMI, menstrual phase, smoking, blood pressure and lipids; Fakhrzadeh et al 16 matched subjects on age, BMI and follow-up period. Postpartum time period of assessment ranged from 2 months to 20 years ( Table 2).…”

“…Seven studies were conducted in Europe, [7][8][9][10][11][12][13] two in Canada, 14,15 one in Iran, 16 two in Turkey, 17,18 one in Brazil 19 and two in the United States. 20,21 Three studies created subgroups for women with previous GDM based on BMI; 7,9,12 two studies created subgroups based on glycaemic levels.…”

“…Six studies 10,11,[14][15][16]20 examined women during either the follicular or luteal phases, whereas one study 7 examined women at various stages during their menstrual cycle. Seven other studies 8,9,12,13,[17][18][19] did not comment on the stage of the women's menstrual cycle. Brewster et al 15 noted the use of oral contraception, and another study 21 included menopausal status.…”

“…Six studies 7,9,14,16,19,20 did not include smokers. Although Akinci et al 18 noted smoking habits, it was not included within their analysis. Two studies 10,17 asked subjects to refrain from smoking 'on the day of the study', while Volpe et al 13 and Gunderson et al 21 included subjects who were smokers.…”

Pregnancy Complications as Markers for Subsequent Maternal Cardiovascular Disease: Validation of a Maternal Recall Questionnaire

“…Introduction P regnancy complications, including gestational diabetes, [1][2][3][4][5] hypertension in pregnancy, [6][7][8][9][10] low birthweight, [11][12][13] and preterm delivery, 12,14 are risk factors for developing cardiovascular disease (CVD) later in life. [15][16][17][18] The 2011 American Heart Association (AHA) ''Guidelines for the Prevention of Cardiovascular Disease in Women'' recommended that healthcare providers take a history of these pregnancies to identify women whose pregnancy history places them at increased risk for future CVD.…”