2146-P: Gestational Blood Pressure Levels and Risk of Gestational and New-Onset Postpartum Diabetes

by sugaradmin



Introduction and Objective: Gestational diabetes (GDM) and hypertensive disorders of pregnancy often co-occur and are the leading causes of maternal morbidity. We aimed to examine whether the risks of GDM and new-onset postpartum diabetes (PPDM) increase across gestational blood pressure (BP) categories following the current guidelines with lower thresholds for hypertension (systolic/diastolic BP ≥130/80 mmHg) among non-pregnant populations.Methods: In a population-based cohort study, 288,072 pregnancies without pre-existing hypertension in Kaiser Permanente were followed up to 12.8 years (mean 5.1; SD 3.5) postpartum (2011-2023). Modified Poisson and Cox regression models calculated adjusted relative risk (aRR) of GDM and adjusted hazard ratio (aHR) of new-onset PPDM, respectively, in association with BP categories based on measurements at ≥2 occasions ≥4 hours apart (normal <120/80 mmHg, elevated 120-129/<80, stage-1 hypertension 130-139/80-89, and stage-2 hypertension ≥140/90) before (for both outcomes) and after (only for PPDM) 20 weeks’ gestation, adjusting for covariates including BMI.Results: The prevalence of the four increasing BP categories was: 74.6%, 12.6%, 9.8%, 3.0% before 20 weeks (used for chronic hypertension diagnosis) and 54.2%, 18.0%, 16.0%, 8.8% after 20 weeks (used for hypertension disorders of pregnancy diagnosis). The aRR (95% CI) of GDM increased across BP categories before 20 weeks [elevated 1.25 (1.20-1.30), stage-1 1.44 (1.39-1.50), stage-2 1.64 (1.54-1.74) vs. normal BP]. Similarly, aHR (95% CI) of PPDM increased across BP categories (vs. normal BP) both before [1.38 (1.28-1.49), 1.78 (1.65-1.91), 2.80 (2.53-3.09)] and after 20 weeks [1.34 (1.24-1.45), 1.59 (1.47-1.71), 1.94 (1.77-2.12)].Conclusion: We observed dose-response associations of BP categories both before and after 20 weeks’ gestation with risk of GDM and PPDM. New BP thresholds may identify women with subclinical high BP in pregnancy at risk of hyperglycemia during and after pregnancy, suggesting opportunities for intervention.

Disclosure

Y. Zhu: None. A. Ngo: None. C. Quesenberry: None. A. Ferrara: None.

Funding

National Heart, Lung, and Blood Institute (R01HL157666)



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