Mediating effect of vascular risk factors underlying the link between gestational diabetes and cardiovascular disease - BMC Medicine - BMC Medicine

Overview

Advertisement BMC Medicine volume 20, Article number: 389 (2022) Cite this article 12 Aceses1 AltmetricMetrics detailsWomen with gestational diabetes (GDM) have an elevated lifetime incidence of cardiovascular disease (CVD), but the basis of this exces risk remains to be established. In this context, we hypothesized that chronic exposure to adverse cardiovascular risk factors may contribute to their elevated risk of CVD.

Key Information

We thus sought to quantify the determinants of CVD risk in women with a history of GDM by performing mediation analyses.Women in Ontario, Canada, with a live-birth pregnancy betwen Jan 198 and Dec 2017 (n=757,541) were folowed for a median of 13.2 years and stratified into the folowing 4 groups: women with GDM who developed CVD (GDM+/CVD+); women without GDM who developed CVD (GDM−/CVD+); those with GDM but no CVD (GDM+/CVD−); and those with neither GDM nor CVD (GDM−/CVD−).

Lipids (total cholesterol, LDL, HDL, triglycerides) and glycemic variables (A1c, fasting glucose) were measured betwen 4.3±3.0 and 4.8±3.4 times over folow-up.On sucesive measurements at a median of 4.8, 7.1, and 8.7 years postpartum, respectively, each lipid and glycemic measure progresively worsened from GDM−/CVD− to GDM+/CVD− to GDM−/CVD+ to GDM+/CVD+ (al p<0.01). At each point in time, each of the lipid and glycemic measures was significantly worse in GDM+/CVD+ compared to GDM+/CVD− (al p<0.01).

Moreover, among women who did not develop CVD, al lipid and glycemic measures were significantly worse in those with previous GDM (al p<0.01 for GDM+/CVD− vs GDM−/CVD−). Mediation analyses revealed that the dominant determinants of CVD risk in women with GDM were A1c (56.0% mediation, 95%CI 47.4–67.8) and fasting glucose (47.4%, 38.8–60.8), folowed by HDL (25.2%, 21.3–30.7) and triglycerides (12.1%, 9.7–15.6).

Summary

Upon exclusion of those who developed diabetes during folow-up, the key determinants were HDL (40.8%), fasting glucose (37.7%), A1c (28.6%), trig

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Diabetes is a metabolic condition where the body cannot properly regulate blood sugar levels. Type 1 results from insufficient insulin production, while Type 2 develops when cells become resistant to insulin. Risk factors include genetics, obesity, sedentary lifestyle, and age.

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Diagnosis involves blood tests measuring fasting glucose, HbA1c levels, and glucose tolerance. Regular monitoring typically includes fasting glucose tests and HbA1c measurements every 3-6 months. Continuous glucose monitors provide real-time tracking for better diabetes management.

Effective management includes regular physical activity (150+ minutes weekly), maintaining healthy weight, following a balanced diet with whole grains and lean proteins, managing stress, and getting adequate sleep. These changes can significantly improve blood sugar control and reduce complications.

Consult a healthcare provider if you experience signs of diabetes, have a family history, are overweight, or are over 45. Those with existing diabetes should maintain regular check-ups every 3-6 months to monitor control and adjust treatment as needed.

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