Ravi Retnakaran1,2,3, Baiju R Shah4,5,6,7. 1. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada. 2. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. 3. Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada. 4. Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada baiju.shah@ices.on.ca. 5. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada. 6. Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 7. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of cardiovascular disease, which has been attributed to an adverse cardiovascular risk factor profile that is apparent even within the first year postpartum. Given its presence in the early postpartum, we hypothesized that this adverse cardiovascular risk factor profile may develop over time in the years before pregnancy. RESEARCH DESIGN AND METHODS: With population-based administrative databases, we identified all nulliparous women in Ontario, Canada, who had singleton pregnancies between January 2011 and December 2016 and two or more measurements of the following analytes between 2007 and the start of pregnancy: A1C, fasting glucose, random glucose, lipids, and transaminases. This population consisted of 8,047 women who developed GDM and 93,114 women who did not. RESULTS: The two most recent pregravid tests were performed at a median of 0.61 years and 1.86 years before pregnancy, respectively. Women who went on to develop GDM had higher pregravid A1C, fasting glucose, random glucose, LDL cholesterol, triglycerides, and ALT and lower HDL cholesterol than their peers (all P < 0.0001). Notably, in the years before pregnancy, women who went on to develop GDM had higher annual increases than their peers in A1C (1.9-fold higher) (difference 0.0089%/year [95% CI 0.0043-0.0135]) and random glucose (4.3-fold), greater annual decrease in HDL cholesterol (5.5-fold), and lesser annual decline in LDL cholesterol (0.4-fold) (all P ≤ 0.0002). During this time, fasting glucose and triglycerides increased in women who developed GDM but decreased in their peers (both P < 0.0001). CONCLUSIONS: The adverse cardiovascular risk factor profile of women with GDM evolves over time in the years before pregnancy.
OBJECTIVE:Women who develop gestational diabetes mellitus (GDM) have an elevated lifetime risk of cardiovascular disease, which has been attributed to an adverse cardiovascular risk factor profile that is apparent even within the first year postpartum. Given its presence in the early postpartum, we hypothesized that this adverse cardiovascular risk factor profile may develop over time in the years before pregnancy. RESEARCH DESIGN AND METHODS: With population-based administrative databases, we identified all nulliparous women in Ontario, Canada, who had singleton pregnancies between January 2011 and December 2016 and two or more measurements of the following analytes between 2007 and the start of pregnancy: A1C, fasting glucose, random glucose, lipids, and transaminases. This population consisted of 8,047 women who developed GDM and 93,114 women who did not. RESULTS: The two most recent pregravid tests were performed at a median of 0.61 years and 1.86 years before pregnancy, respectively. Women who went on to develop GDM had higher pregravid A1C, fasting glucose, random glucose, LDL cholesterol, triglycerides, and ALT and lower HDL cholesterol than their peers (all P < 0.0001). Notably, in the years before pregnancy, women who went on to develop GDM had higher annual increases than their peers in A1C (1.9-fold higher) (difference 0.0089%/year [95% CI 0.0043-0.0135]) and random glucose (4.3-fold), greater annual decrease in HDL cholesterol (5.5-fold), and lesser annual decline in LDL cholesterol (0.4-fold) (all P ≤ 0.0002). During this time, fasting glucose and triglycerides increased in women who developed GDM but decreased in their peers (both P < 0.0001). CONCLUSIONS: The adverse cardiovascular risk factor profile of women with GDM evolves over time in the years before pregnancy.
Authors: Roslyn Mainland; Shi Wu Wen; Hongzhuan Tan; Shujin Zhou; Chang Ye; Minxue Shen; Graeme N Smith; Mark C Walker; Ravi Retnakaran Journal: Womens Health Rep (New Rochelle) Date: 2021-03-23
Authors: Ravi Retnakaran; Shi Wu Wen; Hongzhuan Tan; Shujin Zhou; Chang Ye; Minxue Shen; Graeme N Smith; Mark C Walker Journal: JAMA Netw Open Date: 2021-12-01
Authors: Eline G M van Hoorn; Peter R van Dijk; Jelmer R Prins; Helen L Lutgers; Klaas Hoogenberg; Jan Jaap H M Erwich; Adriaan Kooy Journal: BMJ Open Date: 2022-03-30 Impact factor: 2.692