Gestational Diabetes May Increase Risk for Hypertension, Ischemic Heart Disease, T2D

Women who are diagnosed with gestational diabetes during pregnancy are at increased risk for hypertension and ischemic heart disease (IHD) as well as for type 2 diabetes, according to a population-based retrospective cohort study published in PLoS Medicine.¹

Although it has been well established that women who have gestational diabetes are at an increased lifetime risk for type 2 diabetes,^2,3 there are few data available on the association of gestational diabetes and cardiovascular disease.

Researchers in the United Kingdom used a large primary care database to identify 9118 women diagnosed with gestational diabetes and matched them with 37,281 control women by age and timing of pregnancy (up to 3 months).¹

They found that women diagnosed with gestational diabetes were more than 20 times more likely to have type 2 diabetes develop, 2.8 times more likely to have IHD develop, and had almost twice the risk for hypertension compared with the control group.

This increased risk continued throughout the 25-year follow-up period. However, less than 60% of women diagnosed with gestational diabetes were screened for type 2 diabetes in the first year postpartum, and this proportion decreased to less than 40% by the second year. Postpartum screening rates were much lower for cardiovascular risk factors such as hypertension, dyslipidemia, smoking, and high body mass index in patients with gestational diabetes.   

The investigators noted that, “results showed that women diagnosed with [gestational diabetes] were significantly more likely to [have] type 2 diabetes, hypertension, and IHD [develop] at a relatively young age compared with women without a previous diagnosis of gestational diabetes.” Guideline recommendations for screening and management of hypertension, lipids, and smoking cessation are lacking and need to be reviewed,”¹ concluded the researchers.

References

1. Daly B, Toulis KA, Thomas N, et al. 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 [published online January 16, 2018]. PLoS Med. doi: 10.1371/journal.pmed.1002488
2. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25:1862-1868.
3. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-1779.