Gestational Diabetes Associated with Increased Risks of Cardiovascular, Cerebrovascular Diseases

A new study has found that gestational diabetes mellitus is associated with an increased risk of overall and type-specific cardiovascular and cerebrovascular diseases in women, according to results published in the BMJ.

Data have estimated that the prevalence of gestational diabetes ranged from 1% to more than 30% and is associated with higher risks of adverse maternal and neonatal outcomes, including pre-eclampsia, preterm birth, still birth, large size for gestational age, and neonatal hyperinsulinemia. Although it typically resolves after birth, a growing number of studies suggest that the impacts of gestational diabetes can persist over time.

One earlier study found that women with gestational diabetes both with and without future development of diabetes have increased risks of coronary artery diseases. However, knowledge about specific cardiovascular diseases such as myocardial infraction and heart failure in women with gestational diabetes is still limited.

In order to quantify the risks of overall and type-specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes, investigators conducted a systematic review and meta-analyses.

Fifteen studies rated as moderate or serious risk of bias were included in the analysis. Out of 513,324 women with gestational diabetes, 9507 had cardiovascular and cerebrovascular disease. Out of more than 8 million control women without gestational diabetes, 78,895 had cardiovascular and cerebrovascular disease.

Compared with women without gestational diabetes, the researchers found that women with a history of gestational diabetes had a 45% increased risk of overall cardiovascular and cerebrovascular diseases. Specifically, women in this population had a 72% increased risk for cardiovascular diseases and 40% for cerebrovascular diseases.

The investigators also found that women with gestational diabetes showed increased risks of incident coronary artery diseases, myocardial infarction, heart failure, angina pectoris, cardiovascular procedures, stroke, and ischemic stroke. The risk of venous thromboembolism was observed to increase by 28% in women with previous gestational diabetes.

Subgroup analyses of cardiovascular and cerebrovascular disease outcomes were also performed and were stratified by study characteristics and adjustments. They showed differences by region, study design, source of data, study quality, adjustment for smoking, body mass index, socioeconomic status, and comorbidities.

However, the risk of cardiovascular and cerebrovascular diseases was attenuated, but remained significant when limited to women who did not develop subsequent overt diabetes. This heightened risk could not be solely attributed to conventional cardiovascular risk factors, although they were partially mediated by subsequent diabetes. The authors concluded that there is a need for early intervention in women at high risk of gestational diabetes mellitus and for continuous monitoring of women with gestational diabetes.

REFERENCE

Xie W, Wang Y, Xiao S, Qiu L, et al. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ; 2022. Accessed October 4, 2022. https://www.bmj.com/content/378/bmj-2022-070244