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Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women
Open accessAbstract
Importance: Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors including body weight and lifestyle. Objective: To prospectively evaluate history of GD in relation to incident CVD risk. Design, Setting, and Participants: The Nurses' Health Study II (NHS II) is an observational cohort study of US female nurses established in 1989, with ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. Multivariable Cox models estimated the hazard ratio (HR) and 95% CI for CVD risk. We included 89 479 women who reported at least 1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for more than 90% of eligible participants. Exposures: History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years. Main Outcomes and Measures: We observed 1161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records. Results: Participants had a mean (SD) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71). Conclusions and Relevance: Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.
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“Given that GDM is an important precursor of future cardiometabolic complications, women with a history of GDM should regularly be screened not only for diabetes, but also for CV health.[26][27][28][29]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [27]
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“Two recent studies107 108 found no association between gestational diabetes and the risk of stroke (hazard ratio 1.10, 95% confidence interval 0.75 to 1.61; incidence rate ratio 0.95, 95% confidence interval 0.51 to 1.77, respectively).”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [107]
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Metadata
- Authors
- Tobias, D. K., Stuart, J. J., Li, S., Chavarro, J., Rimm, E. B., Rich-Edwards, J., Hu, F. B., Manson, J. E., & Zhang, C.
- Affiliations
- Brigham and Women's Hospital (US)
- Boston University (US)
- Corresponding author
- Zhang, Cuilin
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2017-12-01
- Volume
- 177
- Issue
- 12
- Pages
- 1735
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5820722
- OpenAlex
- W2765330150
- Cited by
- 323
- References
- 56
- Citations by year
- 2026: 28 · 2025: 35 · 2024: 48 · 2023: 32 · 2022: 52 · 2021: 34 · 2020: 30 · 2019: 38 · 2018: 24 · 2017: 1
- FWCI
- 29.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (HHSN275201000020C, UM1-CA-176726, CA176726)
- National Heart, Lung, and Blood Institute (R01HL034594)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK103720)
- National Institute of Child Health and Human Development (HHSN275201000020C)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (# HHSN275201000020C)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- gestational diabetes mellitus, cardiovascular risk, myocardial infarction, stroke, type 2 diabetes progression, pre-pregnancy body mass index, weight gain during pregnancy, lifestyle factors, Nurses' Health Study II, women's health, shared risk factors, incident cardiovascular events, white women
- MeSH terms
- Healthy Lifestyle, Adult, Cardiovascular Diseases, Female, Humans, Pregnancy, Prospective Studies, Surveys and Questionnaires, Risk Factors, United States, Weight Gain, Diabetes, Gestational
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