Abstract:
INCREASED RISK OF ISCHEMIC HEART DISEASE, HYPERTENSION AND TYPE 2 DIABETES IN WOMEN WITH GESTATIONAL DIABETES MELLITUS: A POPULATION-BASED COHORT STUDY*
Barbara Daly1, Konstantinos Toulis2 Neil Thomas2 Krishna Gokhale2 James Martin2 Jonathan Webber3 Deepi Keerthy2, Kate Jolly2 Ponnusamy Saravanan4 Krishnarajah Nirantharakumar2
1School of Nursing, Faculty of Medical and Health Sciences, University of Auckland
2Institute of Applied Health Research, University of Birmingham
3Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust
4Diabetes and Endocrinology, University of Warwick
Aims:
To examine the risk of cardiovascular disease in women previously diagnosed with gestational diabetes mellitus (GDM) in the United Kingdom (UK) and document screening for cardiovascular risk factors in the first three years post-partum in primary care.
Objectives:
To determine the risk of cardiovascular disease, hypertension and type 2 diabetes in women with GDM compared to non-GDM pregnant women.
Methods:
A retrospective cohort study utilising a large primary care database in the UK. From February 1990 to May 2016 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to three months). Adjusted incidence rate ratios (IRR) were calculated for cardiovascular disease and cardiometabolic markers post-partum.
Results:
Women with GDM were more likely to develop type 2 diabetes [IRR=21.96, 95% CI 18.31–26.34] and hypertension [IRR=1.85, 95% CI 1.59–2.16] compared to controls after adjusting for age, Townsend score, BMI and smoking. For ischemic heart disease the IRR was 2.78 [95% CI 1.37–5.66] and for cerebrovascular disease 0·95 [95% CI, 0·51–1.77; p-value=0·87] after adjusting for the above covariates, lipid lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. In the first year post-partum only 58% of women diagnosed with GDM women had a glycaemic measurement and only 48%, 46% and 11% had BMI, smoking status and total cholesterol recorded, respectively; although 80% had blood pressure recorded. Screening rates markedly decreased in the second and third years post-partum.
Conclusions:
GDM women were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and ischemic heart disease. Clinical guidelines should include screening for, and management of cardiovascular risk factors in the post-partum period.