Daly, Barbara, Toulis, Konstantinos A., Thomas, Neil, Gokhale, Krishna, Martin, James, Webber, Jonathan, Keerthy, Deepi, Jolly, Kate, Saravanan, Ponnusamy and Nirantharakumar, Krishnarajah (2018) Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions : a population-based cohort study. PLoS Medicine, 15 (1). e1002488. doi:10.1371/journal.pmed.1002488 ISSN 1549-1676.
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Abstract
Background
Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease.
Methods and findings
We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 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 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. 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) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), 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 and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease.
Conclusions
Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.
Item Type: | Journal Article |
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Subjects: | R Medicine > RG Gynecology and obstetrics |
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
Library of Congress Subject Headings (LCSH): | Diabetes in pregnancy, Coronary heart disease, Non-insulin-dependent diabetes, Hypertension, Women -- Diseases -- Prevention |
Journal or Publication Title: | PLoS Medicine |
Publisher: | Public Library of Science |
ISSN: | 1549-1676 |
Official Date: | 16 January 2018 |
Dates: | Date Event 16 January 2018 Published 11 December 2017 Accepted |
Volume: | 15 |
Number: | 1 |
Article Number: | e1002488 |
DOI: | 10.1371/journal.pmed.1002488 |
Status: | Peer Reviewed |
Publication Status: | Published |
Access rights to Published version: | Open Access (Creative Commons open licence) |
Date of first compliant deposit: | 5 June 2018 |
Date of first compliant Open Access: | 5 June 2018 |
URI: | https://wrap.warwick.ac.uk/102987/ |
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