Introduction and Objective: Gestational diabetes (GDM) increases future cardiovascular disease (CVD) risk, but the link between gestational glucose intolerance (GGI), subclinical hyperglycemia in pregnancy that does not meet criteria for GDM, and CVD is unclear. We examined the association between GGI and future CVD risk.Methods: This was a single-center, retrospective study (1998-2016) in an electronic health record-based pregnancy cohort. We included adults with singleton pregnancies, ≥3 months of postpartum follow-up data, and no history of diabetes or CVD before pregnancy. We categorized deliveries as GGI (defined as an abnormal glucose load test followed by 0 [GGI-0] or 1 [GGI-1] abnormal 3-hour OGTT values), GDM (2-4 abnormal OGTT values), or normoglycemic (reference). The outcome was CVD (composite of coronary artery disease, cerebrovascular disease, peripheral vascular disease, or heart failure), identified with diagnostic and procedure codes. We modeled time from delivery of the first pregnancy to CVD diagnosis using Cox models adjusted for time-invariant (initial age, race/ethnicity) and time-varying factors (1st trimester BMI and systolic blood pressure, chronic hypertension, parity, marital status, insurance, social deprivation index), updated at each delivery.Results: We analyzed 41,909 pregnancies (30,574 women) with a mean (SD) age at delivery of 31.5 (5.6) years; 9%, 3%, and 4% of pregnancies were affected by GGI-0, GGI-1, and GDM, respectively. Over a median follow-up of 11.9 (IQR 4.9, 18.4) years, 2.6% of individuals developed CVD. GDM was associated with higher CVD risk in the unadjusted model (HR 1.57, 95% CI [1.19, 2.07]), but this association was attenuated after covariate adjustment (HR 1.13, [0.85, 1.50]). Like GDM, GGI-1 was associated with CVD only in the unadjusted model (unadjusted HR 1.47, [1.07, 2.02]; adjusted HR 1.13, [0.82, 1.56]). GGI-0 was not associated with CVD in either model.Conclusion: GGI-1 and GDM confer similar CVD risk, but this increased risk can be attributed to pre- or early pregnancy CVD risk factors.
D.C. Soria-Contreras: None. C.F. Escobar-Tomlienovich: None. B. Chambers: None. T. Thaweethai: None. D. Pant: None. S. Hsu: None. K. James: None. J. Maya: None. M. Honigberg: Research Support; Current; Novartis AG. Advisory Panel; Ended; Novartis AG. Other – In-kind study drug; Current; Novartis AG. Research Support; Current; Genentech, Inc. C. Powe: Research Support; Current; Dexcom, Inc. Other – Associate Editor of Diabetes Care, Honoraria for Educational Materials; Current; American Diabetes Association. Other – Royalties for Up To Date chapters; Current; Wolters Kluwer (Up To Date). Other – Speaker; Ended; Medscape.
American Heart Association (25SFRNPCKMS1463896)
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