Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study
Open accessAbstract
Background: Gestational diabetes (GD) leads to earlier onset and heightened risk of type 2 diabetes, a strong risk factor for cardiovascular disease (CVD). However, it is unclear whether attaining normoglycemia can ameliorate the excess CVD risk associated with GD history. This study sought to evaluate GD history and glucose tolerance after pregnancy associated with coronary artery calcification (CAC) in women, a manifestation of atherosclerotic CVD and a predictor of CVD clinical events. Methods: Data were obtained from the CARDIA study (Coronary Artery Risk Development in Young Adults), a US multicenter, community-based prospective cohort of young Black (50%) and White adults aged 18 to 30 years at baseline (1985–1986). The sample included 1133 women without diabetes at baseline, who had ≥1 singleton births (n=2066) during follow-up, glucose tolerance testing at baseline and up to 5 times during 25 years (1986–2011), GD status, and CAC measurements obtained from 1 or more follow up examinations at years 15, 20, and 25 (2001–2011). CAC was measured by noncontrast cardiac computed tomography; dichotomized as Any CAC (score>0) or No CAC (score=0). Complementary log-log models for interval-censored data estimated adjusted hazard ratios of CAC and 95% confidence intervals for GD history and subsequent glucose tolerance groups (normoglycemia, prediabetes, or incident diabetes) on average 14.7 years after the last birth adjusted for prepregnancy and follow-up covariates. Results: Of 1133 women, 139 (12.3%) reported GD and were 47.6 years of age (4.8 SD) at follow-up. CAC was present in 25% (34/139) of women with GD and 15% (149/994) of women with no GD. In comparison with no GD/normoglycemia, adjusted hazard ratios (95% CIs) were 1.54 (1.06–2.24) for no GD/prediabetes and 2.17 (1.30–3.62) for no GD/incident diabetes, and 2.34 (1.34–4.09), 2.13 (1.09–4.17), and 2.02 (0.98–4.19) for GD/normoglycemia, GD/prediabetes, and GD/incident diabetes, respectively (overall P =0.003). Conclusions: Women without previous GD showed a graded increase in the risk of CAC associated with worsening glucose tolerance. Women with a history of GD had a 2-fold higher risk of CAC across all subsequent levels of glucose tolerance. Midlife atherosclerotic CVD risk among women with previous GD is not diminished by attaining normoglycemia.
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Women who sustained normoglycemia after a delivery complicated by GDM could not eliminate their future cardiovascular risk, as evidenced by a >2-fold prevalence of positive coronary artery calcium scores (26.3% vs. 12.9%).
“More surprisingly, women who sustained normoglycemia after a delivery complicated by GDM could not eliminate their future cardiovascular risk, as evidenced by a >2-fold prevalence of positive coronary artery calcium scores (26.3% vs. 12.9%) [67].”
From Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications (2022) · cites this paper as [67]
The Results report positive coronary artery calcium scores in 28.3% of normoglycemic women with prior gestational diabetes, versus 12.9% without it. The Discussion also reports increased CAC risk despite sustained normoglycemia. The cited comparison is more than twofold, but the claimed 26.3% does not match the source’s 28.3%. (LLM, conf=0.91)
Experimental — accuracy not yet measuredWomen with a previous history of GDM have increased coronary artery calcium scores and carotid intima media thickness after delivery.
“As a result, women with a previous history of GDM have increased coronary artery calcium scores and carotid intima media thickness, which are surrogates for atherosclerosis and future CVD, after delivery [66,67].”
From Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications (2022) · cites this paper as [67]
The Results report that CAC was more common in women with previous gestational diabetes (24.5% versus 15.0%), but the study assesses CAC presence and risk rather than establishing higher CAC scores in that group. The Discussion reports greater carotid intima-media thickness only among women without type 2 diabetes or metabolic syndrome; the claim omits that qualifier. These findings concern follow-up into midlife, not necessarily the period immediately after delivery. (LLM, conf=0.88)
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Chen, T., Wu, J., Pan, Q., & Dong, M. (2024) · Figshare · doi:10.6084/m9.figshare.26054768
- Authors
- Gunderson, E. P., Sun, B., Catov, J. M., Carnethon, M., Lewis, C. E., Allen, N. B., Sidney, S., Wellons, M., Rana, J. S., Hou, L., & Carr, J. J.
- Affiliations
- Kaiser Permanente (US)
- University of Pittsburgh (US)
- Northwestern University (US)
- University of Alabama at Birmingham (US)
- Vanderbilt University (US)
- ORCID
- Venue
- Circulation
- Published
- 2021-03-09
- Volume
- 143
- Issue
- 10
- Pages
- 974-987
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC7940578
- OpenAlex
- W3127693441
- Cited by
- 117
- References
- 73
- Citations by year
- 2026: 19 · 2025: 14 · 2024: 37 · 2023: 20 · 2022: 19 · 2021: 8
- FWCI
- 19.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Kaiser Permanente
- Northwestern University
- University of Minnesota
- National Institutes of Health (n01hc48050-59-0-1)
- National Heart, Lung, and Blood Institute (HHSN268201800004I, HHSN268201800005I, N01 HC048050, HHSN268201800006I, HHSN268201800007I, HHSN268201800003I)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK090047, K01DK059944, R01DK106201, P30DK079626)
- 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 › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- gestational diabetes mellitus, coronary artery calcification, glucose tolerance, prediabetes, type 2 diabetes, atherosclerotic cardiovascular disease, middle-aged women, cardiovascular risk
- MeSH terms
- Calcium, Coronary Vessels, Female, Glucose Tolerance Test, Humans, Middle Aged, Pregnancy, Prospective Studies, Risk Factors, Cohort Studies, Diabetes, Gestational
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