Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria

Abstract

OBJECTIVEWomen with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.RESEARCH DESIGN AND METHODSThis cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1–2 and 3–5 was assessed using logistic regression.RESULTSOf 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1–2 (multivariate odds ratio 1.54 [95% CI 1.16–2.05]) similar to the odds for women with overt diabetes (1.68 [1.55–1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1 –2 but not CKD stages 3–5 among women with GDM.CONCLUSIONSWomen with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1–2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.

Gestational Diabetes Mellitus Is a Significant Risk Factor for Long-Term Maternal Renal Disease

“…GDM alone (without subsequent type 2 DM) was found as a risk factor for future development of microalbuminuria. In addition to microalbuminuria, the authors reported that patients with a history GDM had an increased risk for developing future CKD (27). Although this study used a relatively large cohort, it was based on self-report data.…”

“…In the first study, Friedman et al (26) followed 72 patients for 5 to 8 years after the last GDM occurrence and reported a higher risk for microalbuminuria in women with a history of GDM than in the control group. The second study by Bomback et al (27) was a relatively large cohort study (571 women with GDM vs 25 045 women without GDM) that was based on selfreport data. GDM alone (without subsequent type 2 DM) was found as a risk factor for future development of microalbuminuria.…”

Postpartum Microalbuminuria After Gestational Diabetes: The Impact of Current Glucose Tolerance Status

“…In the Kidney Early Evaluation Program (KEEP), women who reported a history of GDM but without subsequent known diabetes had a higher prevalence of microalbuminuria at mean age 51.5 years than did their peers who did not have previous GDM (13). In the Third National Health and Nutrition Examination Survey (NHANES), women with a self-reported history of GDM (n ϭ 85) had higher urine MA/creat than those without such a history (14).…”

“…Specifically, previous studies have reported that women with a history of previous GDM have higher levels of urinary microalbumin than women who do not have a history of GDM, when evaluated between 5 to 11 years after the index pregnancy (13)(14)(15)(16). However, a confounding factor that has not been considered in these studies is the potential impact of concomitant glucose intolerance.…”

A study on clinical characteristics of gestational diabetes mellitus associated with intrauterine fetal death

“…2 Women with a history of gestational diabetes are at increased risk of cardiovascular and kidney disease, regardless of whether they have gone on to develop overt diabetes, growing evidence suggests. 3 Crowther et al and London et al have reported fetal death with gestational diabetes. 4,5 However underlying cause of intrauterine death in mothers with gestational diabetes are unclear.…”