Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis
Open accessAbstract
Aims/hypothesis Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of type 2 diabetes mellitus. Recently, a series of studies has suggested that women with GDM also have an increased risk of cardiovascular disease (CVD). However, it is unclear if this risk is dependent upon the intercurrent development of type 2 diabetes. Thus, we conducted a systematic review and meta-analysis to evaluate the impact of GDM on future risk of incident CVD and to ascertain the role of type 2 diabetes in this regard.Methods We systematically searched the PubMed and EMBASE databases for observational studies that evaluated the association of GDM with subsequent CVD, with publication between 1 January 1950 and 30 August 2018. Two independent reviewers extracted data and the analysis was performed in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. RRs were calculated using a random-effects model to assess the predictive value of GDM for future cardiovascular events. To evaluate whether incident type 2 diabetes in the GDM population influenced the association with CVD, we used meta-regression models followed by sensitivity analyses restricted to women who did not develop type 2 diabetes during follow-up.Results A pooled analysis of nine studies yielded data from 5,390,591 women (101,424 cardiovascular events). Compared with those who did not have GDM, women with GDM had a twofold higher risk of future cardiovascular events (RR 1.98 [95% CI 1.57, 2.50]). Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk (p = 0.34). Moreover, when restricted to women who did not develop type 2 diabetes, GDM remained associated with a 56% higher risk of future cardiovascular events (RR 1.56 [95% CI 1.04, 2.32]). GDM conferred a 2.3-fold increased risk of cardiovascular events in the first decade postpartum (RR 2.31 [95% CI 1.57, 3.39]).Conclusions/interpretation The diagnosis of GDM identifies young women who have a twofold higher risk of cardiovascular events postpartum compared with their peers. This risk is not dependent upon intercurrent type 2 diabetes and is apparent within the first decade after pregnancy. Thus, even without progressing to type 2 diabetes, women with GDM comprise an at-risk population for CVD and hence a potential opportunity for early risk factor surveillance and risk modification.
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GDM has similar effects on future CVD risk in women, independent of obesity and at a fairly young age.
“GDM had similar effects on the risk of women developing future CVDs189,190 (Supplementary Table 4), independent of obesity and at a fairly young age191–194.”
From A global view of hypertensive disorders and diabetes mellitus during pregnancy (2022) · cites this paper as [190]
The Results report that women with prior GDM had nearly twice the risk of future cardiovascular events, and the discussion says the increased risk is evident in young women within the first decade after delivery (page numbers unavailable). The Results also report an association after pooling adjusted estimates, but adjustment factors varied across studies; the paper does not establish that the association is independent of obesity specifically. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe American Heart Association released a scientific statement describing a 2-fold higher risk of developing cardiovascular disease in women with GDM.
“Recently, the American Heart Association released a scientific statement describing a 2-fold higher risk of developing CVD in women with GDM [11,60,61].”
From Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications (2022) · cites this paper as [61]
The Results and Discussion report that women with prior GDM had approximately twice the risk of future cardiovascular events (RR 1.98). But this paper presents that finding as its own meta-analysis, not as a description of an American Heart Association scientific statement. The cited source therefore supports the risk estimate but not the attribution to an AHA statement. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWomen with gestational diabetes mellitus have increased risk of future type 2 diabetes, kidney disease and cardiovascular disease.
“Women with gestational diabetes mellitus have increased risk of future type 2 diabetes, kidney disease and cardiovascular disease. 4 , 5 , 6 , 7”
From Australasian Diabetes in Pregnancy Society ( <scp>ADIPS</scp> ) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes (2025) · cites this paper as [7]
The Introduction states that gestational diabetes predicts future type 2 diabetes, and the Abstract reports a higher risk of future cardiovascular events. The paper does not address future kidney disease; searches for kidney and renal disease found no supporting passage. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe increased risk of cardiovascular disease in women with GDM was independent of the subsequent development of postpartum type 2 diabetes mellitus.
“This increased risk was independent of the subsequent development of postpartum type 2 diabetes mellitus.”
From Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications (2022) · cites this paper as [61]
A 2019 meta-analysis of over 5 million women reported an approximately two-fold higher risk of major CVD events (RR 1.98) in women with a history of GDM.
“A 2019 meta-analysis of over 5 million women reported an approximately two-fold higher risk of major CVD events (RR 1.98) and women who did not progress to T2DM showed a 56% higher risk (RR 1.56) in those with a history of GDM [12].”
In the same 2019 meta-analysis, women with a history of GDM who did not progress to T2DM showed a 56% higher risk (RR 1.56) of major CVD events.
“A 2019 meta-analysis of over 5 million women reported an approximately two-fold higher risk of major CVD events (RR 1.98) and women who did not progress to T2DM showed a 56% higher risk (RR 1.56) in those with a history of GDM [12].”
In women with gestational diabetes mellitus, the increased risk of cardiovascular disease development occurs independently and in addition to the risk attributed to type 2 diabetes development.
“In women with GDM, the increased risk of CVD development occurs independently and in addition to the risk attributed to T2D development [62,63].”
From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [62]
The cardiovascular risk in women with GDM is independent of the intercurrent development of T2DM.
“This is in line with a recent meta-analysis showing that women with GDM had a two-fold higher risk for future cardiovascular events and that this cardiovascular risk is independent of the intercurrent development of T2DM [56].”
From The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis (2019) · cites this paper as [56]
Women with GDM had a two-fold higher risk for future cardiovascular events.
“This is in line with a recent meta-analysis showing that women with GDM had a two-fold higher risk for future cardiovascular events and that this cardiovascular risk is independent of the intercurrent development of T2DM [56].”
From The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis (2019) · cites this paper as [56]
Gestational diabetes is an important precursor of future cardiometabolic complications.
“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 [26]
Women with a history of gestational diabetes have a greater risk of composite cardiovascular disease than those without gestational diabetes.
“Women with a history of gestational diabetes had a greater risk of composite cardiovascular disease than those without gestational diabetes (table 1).62”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [62]
The risk of composite cardiovascular disease in women with a history of gestational diabetes is highest in the first decade after pregnancy.
“The risk was highest in the first decade after pregnancy.62”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [62]
When the analysis is limited to women who did not go on to develop diabetes mellitus after gestational diabetes, the risk of composite cardiovascular disease is slightly less but remains statistically significant.
“When the analysis was limited to women who did not go on to develop diabetes mellitus after gestational diabetes, the risk was slightly less but remained statistically significant (supplementary table 3).62”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [62]
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“2018 [56] Retrospective cohort study, Canada NR NR NR NR NR No matched controls NR”
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- Authors
- Kramer, C. K., Campbell, S., & Retnakaran, R.
- Affiliations
- Mount Sinai Hospital (CA)
- Corresponding author
- Retnakaran, Ravi
- Venue
- Diabetologia
- Published
- 2019-03-07
- Volume
- 62
- Issue
- 6
- Pages
- 905-914
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2921935358
- Semantic Scholar
- 87801df0711328b6dbc1cde08d51702ee5195d9d
- Cited by
- 965
- References
- 32
- Citations by year
- 2026: 132 · 2025: 143 · 2024: 175 · 2023: 149 · 2022: 156 · 2021: 112 · 2020: 74 · 2019: 23
- FWCI
- 14.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- 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, type 2 diabetes, postpartum period, women's health, cardiovascular events, postpartum cardiovascular risk, pregnancy outcomes, cardiovascular risk prediction
- MeSH terms
- Animals, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Pregnancy, Risk Factors, Women's Health, Diabetes, Gestational
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