History of Gestational Diabetes and Risk for Atherosclerotic CVD During Midlife

The risk for coronary artery calcification (CAC) was found to be greater in women with a history of gestational diabetes (GD) despite attaining normoglycemia after pregnancy, according to a study published in Circulation.

In this multicenter, prospective cohort study (Coronary Artery Risk Development in Young Adults; ClinicalTrials.gov Identifier: NCT00005130), 5115 women were recruited in Birmingham, Chicago, Minneapolis, and Oakland starting in 1985. Most participants (72%) were retained through a 25-year follow-up. A subset of women (n=1133) who had singleton births between baseline and follow-up were assessed by computed tomography and for presence of GD.

In this cohort, 51% of women were White, 49% Black, and 12.3% had GD. The average age of first birth after baseline was 30.1±4.9 years. Mean age at study conclusion was 47.6±4.8 years.

Women who had vs did not have GD were more likely to become prediabetic (36% vs 35%, respectively) or develop incident diabetes (25.9% vs 9%, respectively) after pregnancy than to maintain normoglycemia (38.1% vs 56%, respectively; P <.001).

CAC >0 was detected in 16.2% of participants. Women with vs without previous GD had higher incidence of CAC (24.5% vs 15.0%, respectively; P =.005). The prevalence of CAC was greater among women who were normoglycemic and had previous GD (28.3%) compared with those without a history of GD (12.9%; P =.002).

Glucose tolerance tended to worsen with increased CAC (P =.003).

Risk for CAC was greater in: women without a history of GD but with prediabetes (adjusted hazard ratio [aHR], 1.52; 95% CI, 1.04-2.22); women with no history of GD but with incident diabetes (aHR, 1.82; 95% CI, 1.08-3.09); women with a history of GD (aHR, 1.66; 95% CI, 1.13-2.42); women with a history of GD and prediabetes (aHR, 2.11; 95% CI, 1.07-4.14); and in women with a history of GD who were normoglycemic (aHR, 2.25; 95% CI, 1.29-3.94).

This study may have been limited of the lack of pre-pregnancy CAC assessments.

“[T]his study adds to the mounting evidence that enhanced CVD risk factor screening among women with a history of GD is needed to better risk stratify women for early [atherosclerotic cardiovascular disease] prevention,” concluded the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Gunderson E P, Sun B, Catov J M, et al. Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study. [published online February 1, 2021] Circulation. doi:10.1161/CIRCULATIONAHA.120.047320