Pregnant women with gestational diabetes who experience stillbirth are nearly 50 times more likely to develop type 2 diabetes later in life, researchers reported at the European Association for the Study of Diabetes Annual Meeting.

Basilio Pintaudi, MD, of the Fondazione Mario Negri Sud in Italy, and colleagues conducted a population-based cohort study with administrative data from 12 local health authorities in Puglia, Italy to estimate type 2 diabetes incidence and cardiovascular (CV) events in women with previous gestational diabetes and in those with normal glucose tolerance in pregnancy.

Their aim was to assess how stillbirth affected these risks.

The researchers identified 2.1 million women diagnosed with gestational diabetes from 2002 to 2010 and matched them on a 1 to 3 basis with women without gestational diabetes or type 2 diabetes.

Women were matched according to age, local health authority code and use of antihypertensive and antithrombotic agents, according to a press release.

A total of 3,851 women with gestational diabetes (mean age, 37 years) and 11,553 matched controls without gestational diabetes were included in the final analysis. They were followed for a median of 5.4 years.

Results revealed a type 2 diabetes incidence rate of 2.1 per 1,000 women per year in those without gestational diabetes, 54.0 per 1,000 women per year in those with gestational diabetes and pregnancy at term and 115.0 per 1,000 women per year in women with gestational diabetes and whose pregnancy ended in stillbirth, according to data reported in the release.

Analyses indicated that women with gestational diabetes had 22 times the risk for type 2 diabetes, and women with gestational diabetes complicated by stillbirth had 47 times the risk for type 2 diabetes, as compared with women with normal pregnancies.

Risk for CV events was also 2.4 times higher with gestational diabetes and 16.7 times higher with stillbirth occurring with gestational diabetes vs. normal pregnancy.

The researchers noted that these findings suggest women whose pregnancies were complicated by gestational diabetes and ended in stillbirth should receive careful follow-up, as they appear to be at an increased risk for developing type 2 diabetes and experiencing CV events.

“The most important action should be to act on modifiable risk factors such as diet and physical exercise aiming to an intensive lifestyle change and cutting out unhealthy habits. A specific intensive and personalized cardiovascular and metabolic follow-up, including recommendations on lifestyle, should be planned for these high-risk women,” the researchers said in the release.

“Since most of the women who have had gestational diabetes do not comply with the recommendations to have a post-pregnancy glucose tolerance test, health care professionals should also increase their efforts to motivate these high-risk women to attend screening programs,” they added.

Reference

  1. Pintaudi B et al. Oral Presentation 154. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 15-19, 2014; Vienna, Austria.