Overview
Advertisement BMC Medicine volume 20, Article number: 389 (202) 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