Gestational diabetes may up risk of atherosclerosis

Women who develop gestational diabetes but have no history of type 2 diabetes or metabolic syndrome may be at increased risk for subclinical atherosclerosis, regardless of whether they are obese before pregnancy or not, based on the findings of a study published online March 12 in the Journal of the American Heart Association.

Researchers led by Erica P. Gunderson, PhD, MS, MPH, of Kaiser Permanente Northern California, analyzed data from women participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a trial evaluating risk factors involved in coronary heart disease among young black and white adults.

Gunderson and her co-investigators studied 898 women who enrolled in CARDIA during the 1985-1986 baseline period and had no history of type 2 diabetes or heart disease. The women also delivered at least one live infant after the baseline period. In addition, the women’s common carotid intima media thickness (ccIMT) was measured in 2005-2006. 

Among the 898 women, 13 percent reported gestational diabetes. Unadjusted average ccIMT was 0.023 mm higher for women with gestational diabetes, but the effect was diminished to 0.016 mm when pre-pregnancy body mass index was taken into account.

In the women who did not develop diabetes or metabolic syndrome, average ccIMT was 0.023 mm higher in women who had gestational diabetes compared with the women who did not after controlling for race, age, parity and pre-pregnancy body mass index. Of the women who developed diabetes or metabolic syndrome, mean ccIMT did not differ based on a history of gestational diabetes.

The authors argued that their findings support postpartum screening for risk factors for cardiovascular disease in women with a history of gestational diabetes.

“Women with a history of GDM [gestational diabetes mellitus] display atherosclerotic changes to the endothelium at much earlier ages than most women, and therefore effective early prevention efforts should be focused on these women during the postpartum period, including those who have not yet developed overt diabetes or metabolic diseases,” they wrote.