Gestational Diabetes Increases Long-Term Risk for Wide Array of Cardiovascular Conditions

Seung Mi Lee, MD

An analysis of data from the UK Biobank study is providing clinicians with a comprehensive overview of the long-term cardiovascular risks associated with a diagnosis of gestational diabetes mellitus.

The study, which was presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, suggests women were at a wider range of cardiovascular comorbidities than previous data had indicated, with gestational diabetes associated with an increased risk of CAD, PAD, myocardial infarction, stroke, heart failure, mitral regurgitation, and atrial fibrillation (AF).

“We’ve known that gestational diabetes can lead to heart problems,” said study investigator Seung Mi Lee, MD, a maternal-fetal subspecialist and associate professor of obstetrics and gynecology at Seoul National University College of Medicine, in a statement. “This research shows us the extent of heart health problems that can arise long after someone has given birth. The next step is to look at what kind of preventative measures can be taken during pregnancy to hopefully prevent cardiovascular disease from developing later in life.”

Although mountains of data have detailed the link between gestational diabetes and increased risk of atherosclerotic cardiovascular disease, Mi Lee and colleagues noted a dearth of evidence related to the range of cardiovascular outcomes in midlife among women with a history of gestational diabetes. With this in mind, investigators sought to estimate these associations using data from the UK Biobank study.

Using the UK Biobank cohort, investigators identified 219,330 women with at least 1 live birth from 2006-2010 for inclusion in their analyses. For the purpose of analysis, investigators used multivariable Cox proportional hazard models to assess associations of gestational diabetes with new incidence of diverse cardiovascular outcomes. Investigators pointed out causal mediation analysis was used to estimate the contribution of known risk factors to observed risk in this cohort. Cardiovascular outcomes of interest for the study included total outcomes, CAD, PAD, myocardial infarction, ischemic stroke, heart failure, aortic stenosis, mitral regurgitation, AF, and venous thromboembolism.

During the follow-up period, 13,094 (6.0%) developed a new cardiovascular outcome. In the investigators' analyses, women with a history of gestational diabetes had an increased risk of total cardiovascular outcomes than those without a history of gestational diabetes (7.80 vs 5.81 new events per 1000 person-years; P <.001). When assessing individual outcomes, results of adjusted analyses suggested gestational diabetes was associated with an increased risk of CAD (HR, 1.330 [95% CI, 1.192-1.563]; P=.003), PAD (HR, 1.064 [95% CI, 1.164-2.562]; P=0.007), myocardial infarction (HR, 1.678 [95% CI, 1.289-2.185] ; P <.001), ischemic stroke (HR, 1.696 [1.188-2.414]; P=.004), heart failure (HR, 1.426 [95% CI, 1.078-1.897]; P=.013), mitral regurgitation (HR, 2.276 [955 CI, 1.524-3.358]; P <.001), and AF (HR, 1.474 [95% CI, 1.181-1.842]; P <.001).

Investigators pointed out no increase or a nonsignificant increase in risk was observed for aortic stenosis (HR, 0.848 [95% CI, 0.379-1.900]; P=.689) and venous thromboembolism (HR, 1.064 [95% CI, 0.777-1.455] P=.699). Investigators also pointed out results of a mediation analysis suggested subsequent overt diabetes explained 23%, hypertension explained 11%, and dyslipidemia explain 10% of the association between gestational diabetes and overall cardiovascular outcomes.

This study, “Long-term cardiovascular outcomes of gestational diabetes mellitus: a prospective population-based UK Biobank study,” was presented the SMFM annual meeting, The Pregnancy Meeting.