Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study
Open accessAbstract
BACKGROUND: Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease. METHODS AND FINDINGS: We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31-26.34) and hypertension (IRR = 1.85; 95% CI 1.59-2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37-5.66), and for cerebrovascular disease 0.95 (95% CI 0.51-1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease. CONCLUSIONS: Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.
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Two recent studies found no association between gestational diabetes and 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).
“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 [108]
Our previous study found insufficient reporting of gestational diabetes and screening for cardiovascular risk factors in these women.
“Our previous study found insufficient reporting of gestational diabetes and screening for cardiovascular risk factors in these women”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [108]
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BackgroundInfluentialMetabolic syndrome in women with previous gestational diabetes
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- Authors
- Daly, B., Toulis, K. A., Thomas, N., Gokhale, K., Martin, J., Webber, J., Keerthy, D., Jolly, K., Saravanan, P., & Nirantharakumar, K.
- Affiliations
- University of Auckland (NZ)
- University of Birmingham (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- University of Warwick (GB)
- Corresponding author
- Nirantharakumar, Krishnarajah
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-01-16
- Volume
- 15
- Issue
- 1
- Pages
- e1002488
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC5770032
- OpenAlex
- W2782684935
- Cited by
- 328
- References
- 40
- Citations by year
- 2026: 17 · 2025: 42 · 2024: 47 · 2023: 56 · 2022: 41 · 2021: 47 · 2020: 27 · 2019: 31 · 2018: 20
- FWCI
- 35.20
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-07-18)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Funders
- Medical Research Council (MR/J000094/1, MR/N006232/1, MC_PC_15079)
- 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, type 2 diabetes, ischemic heart disease, hypertension, cerebrovascular disease, cardiovascular risk factors, postpartum women, primary care, preventive interventions, cardiovascular risk
- MeSH terms
- Adolescent, Adult, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Hypertension, Middle Aged, Pregnancy, Retrospective Studies, Risk Factors, Cohort Studies, Diabetes, Gestational, Myocardial Ischemia, Young Adult
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