The life course perspective of gestational diabetes: An opportunity for the prevention of diabetes and heart disease in women

Fu, Jennifer; Retnakaran, Ravi

doi:10.1016/j.eclinm.2022.101294

Cited by 37 publications

(51 citation statements)

References 85 publications

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“…Diabetes showed stronger associations with ischemic heart disease [relative risk (95% CI): 2.46 (2.39–2.53)] and other forms of heart disease [1.98 (1.88–2.08)] than cerebrovascular disease [1.70 (1.61–1.80) in women in US adults ( 32 ). Second, in patients with GDM, the underlying metabolic defects including chronic beta-cell dysfunction and insulin resistance could increase levels of glycemia, LDL cholesterol, blood pressure and adiposity, but decrease HDL cholesterol levels, which in together increase the risks of CHD, stroke and heart failure ( 8 ). Abnormal expression of cardiovascular diseases associated microRNAs was observed 3–11 years after delivery in women with a history of GDM ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis of 9 studies found a 2-fold higher risk of subsequent overall cardiovascular diseases in women with a history of GDM than women without GDM ( 7 ). Therefore, the diagnosis of GDM provides unique opportunities for early intervention and risk modification of cardiovascular diseases ( 8 , 9 ), although screening for cardiovascular disease has not been included in current guidelines for the care of women with a history of GDM ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Mao

Hu²,

Xia

et al. 2022

Front. Public Health

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ObjectiveGestational diabetes mellitus (GDM) has been linked to subsequent overall cardiovascular diseases. However, evidence on the associations of GDM with type-specific cardiovascular diseases is lacking, and findings on the potential impact of type 2 diabetes on the associations are not consistent. This study aimed to explore the associations between GDM and the risks of type-specific cardiovascular diseases.MethodsData were from 12,025 women (≥20 years) who had delivered at least one live birth in the National Health and Nutrition Examination Survey, 2007–2018. GDM history and type-specific cardiovascular diseases including coronary heart disease (CHD), heart failure and stroke were defined by self-report. We also combined our results with those from previously related publications on the associations between GDM and risks of type-specific cardiovascular diseases with a random-effect model.ResultsCompared with women without GDM, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.82 (1.21–2.72) for CHD, 1.43 (0.80–2.53) for heart failure, and 1.19 (0.76–1.86) for stroke among women with a history of GDM. Type 2 diabetes was associated with 43.90, 67.44, and 63.16% of the excess odds of CHD, heart failure and stroke associated with GDM, respectively. Combining results from this study with those from previously related studies yielded odds ratios (95% confidence intervals) of 1.81 (1.60–2.05) for CHD (12 studies, 7,615,322 participants, I2= 72.6%), 1.66 (1.25–2.21) for heart failure (5 studies, 4,491,665 participants, I2= 88.6%), and 1.25 (1.07–1.46) for cerebrovascular disease (9 studies, 6,090,848 participants, I2= 77.8%).ConclusionsGDM showed stronger associations with coronary heart diseases and heart failure than cerebrovascular disease, and the excess risks are attributable, in part, to type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Mao

Hu²,

Xia

et al. 2022

Front. Public Health

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“…Accordingly, while the current study cannot account for all determinants of CVD risk in women with previous GDM, the risk mediated by these downstream glycemic and lipid variables remains valid and relevant. Indeed, the importance of this demonstration is further underscored by the fact women with GDM comprise a relatively young population that is identified early in the course of trajectories of worsening glycemia and dyslipidemia over time [16,17,25], such that early intervention could potentially modify their future risk of CVD. Another potential limitation of the study is that potential bias could be introduced to the traditional mediation analysis methodology used here by interaction between the mediator and the exposure or by confounding between the mediator and the outcome [26].…”

Section: Discussionmentioning

confidence: 99%

Mediating effect of vascular risk factors underlying the link between gestational diabetes and cardiovascular disease

Retnakaran

Shah

2022

BMC Med

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Background Women with gestational diabetes (GDM) have an elevated lifetime incidence of cardiovascular disease (CVD), but the basis of this excess risk remains to be established. In this context, we hypothesized that chronic exposure to adverse cardiovascular risk factors may contribute to their elevated risk of CVD. We thus sought to quantify the determinants of CVD risk in women with a history of GDM by performing mediation analyses. Methods Women in Ontario, Canada, with a live-birth pregnancy between Jan 1998 and Dec 2017 (n=757,541) were followed for a median of 13.2 years and stratified into the following 4 groups: women with GDM who developed CVD (GDM+/CVD+); women without GDM who developed CVD (GDM−/CVD+); those with GDM but no CVD (GDM+/CVD−); and those with neither GDM nor CVD (GDM−/CVD−). Lipids (total cholesterol, LDL, HDL, triglycerides) and glycemic variables (A1c, fasting glucose) were measured between 4.3±3.0 and 4.8±3.4 times over follow-up. Results On successive measurements at a median of 4.8, 7.1, and 8.7 years postpartum, respectively, each lipid and glycemic measure progressively worsened from GDM−/CVD− to GDM+/CVD− to GDM−/CVD+ to GDM+/CVD+ (all p<0.0001). At each point in time, each of the lipid and glycemic measures was significantly worse in GDM+/CVD+ compared to GDM+/CVD− (all p<0.001). Moreover, among women who did not develop CVD, all lipid and glycemic measures were significantly worse in those with previous GDM (all p<0.001 for GDM+/CVD− vs GDM−/CVD−). Mediation analyses revealed that the dominant determinants of CVD risk in women with GDM were A1c (56.0% mediation, 95%CI 47.4–67.8) and fasting glucose (47.4%, 38.8–60.8), followed by HDL (25.2%, 21.3–30.7) and triglycerides (12.1%, 9.7–15.6). Upon exclusion of those who developed diabetes during follow-up, the key determinants were HDL (40.8%), fasting glucose (37.7%), A1c (28.6%), triglycerides (21.0%), and LDL (9.9%). Conclusions Adverse glycemic and lipid measures mediate the elevated risk of CVD in women with previous GDM, with the impact of lipids particularly evident in those who do not develop diabetes. These findings thus identify potential targets for risk factor monitoring and ultimately early intervention towards the goal of primary prevention of CVD in this at-risk patient population.

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“…In addition to a higher risk of long-term T2DM, a series of cardiovascular and metabolic diseases, such as obesity (BMI ≥ 30 kg/m 2 ), hypertension, and dyslipidemia, may also occur in women with a history of GDM. A large cohort study also showed a higher incidence of ischemic heart disease in women with a history of GDM [8] . In addition, a recent population-based study in Canada has revealed that women who did not meet the diagnostic criteria for GDM but with hyperglycemia also had a higher risk of cardiovascular disease [9] .…”

Section: Introductionmentioning

confidence: 92%

Risk Factors of Postpartum Cardiovascular Disease in Patients with Gestational Diabetes Mellitus

Liu

Wang

et al. 2022

JCNR

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Objective: To investigate the risk factors of postpartum cardiovascular disease in patients with gestational diabetes mellitus (GDM). Methods: From December 2020 to December 2021, pregnant women who underwent 75-g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation and were diagnosed with GDM were selected as the research subjects. These women were followed-up after delivery. Results: The average fasting plasma glucose (FPG) levels of these women were 6.25 ± 1.36 mmol/L before discharge and 5.01 ± 1.45 mmol/L at 42 days after delivery; the average 2-hour plasma glucose (2hPG) levels were 11.23 ± 2.01 mmol/L before discharge and 7.98 ± 1.23 mmol/L at 42 days after delivery; the average insulin levels were 8.36 ± 1.98 mmol/L before discharge and 2.98 ± 1.36 mmol/L at 42 days after delivery. There were 46 patients with postpartum cardiovascular disease, with an incidence rate of 22.89%. Conclusion: By improving the postpartum management of patients, the weight of GDM patients can be better controlled, their insulin sensitivity can be increased, and the occurrence of glucose and lipid metabolism disorders can be reduced.

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The life course perspective of gestational diabetes: An opportunity for the prevention of diabetes and heart disease in women

Cited by 37 publications

References 85 publications

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Mediating effect of vascular risk factors underlying the link between gestational diabetes and cardiovascular disease

Risk Factors of Postpartum Cardiovascular Disease in Patients with Gestational Diabetes Mellitus

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