Gestational diabetes increases risk of heart and brain disease • The Medical Republic

CVD risk factors and subsequent diagnosis of diabetes do not appear to be to blame, leading to calls for early intervention and continued monitoring in these women.

Women with gestational diabetes are at higher risk for long-term heart and brain problems, underscoring the need for early intervention in high-risk women and ongoing monitoring of women who develop the disease.

Although the link between gestational diabetes and cardiovascular disease has been shown previously, this study suggests that the elevated risks are not due to conventional cardiovascular risk factors or the later development of diabetes in women’s lives.

The systematic review and meta-analysis of 15 studies involving nearly nine million women found that women with a history of gestational diabetes mellitus had a 72% higher risk of developing cardiovascular disease and a 40% increased risk % of cerebrovascular diseases compared to those without. .

Specifically, there was a 40% increased risk of incident coronary heart disease, a 74% increased risk of myocardial infarction, a 62% increased risk of heart failure, a 127% increased risk of chest, an 87% increased risk of cardiovascular interventions, a 49% increased risk increased risk of stroke, 49% increased risk of ischemic stroke and 28% increased risk of venous thromboembolism.

“Women with a history of gestational diabetes mellitus are at significantly higher risk for future cardiovascular and cerebrovascular disease,” the authors wrote in the BMJ.

“This excess risk cannot be solely attributed to conventional cardiovascular risk factors, which were partially mediated by subsequent diabetes.

“Our results underscore the need for early intervention in women at high risk for gestational diabetes mellitus and continued monitoring of women with a history of gestational diabetes mellitus after pregnancy,” they noted.

The risks remained even after the researchers adjusted for ethnicity, sociodemographic characteristics, education, conventional cardiovascular and cerebrovascular risk factors, and subsequent diabetes diagnosis.

“The precise mechanisms of the contribution of gestational diabetes mellitus to the increased risk of cardiovascular and cerebrovascular disease remain unknown,” the authors said.

They pointed to previous research that suggested that about a quarter of cardiovascular risk in women with gestational diabetes could be explained by these women later developing diabetes. However, the current study took this into account, suggesting that the links could be explained by endothelial changes and dysfunction, which could be accelerated in women with obesity and dyslipidemia in women with gestational diabetes.

At the same time, another study published in the BMJ on women with gestational diabetes found that a healthy lifestyle reduced the risk of type 2 diabetes by up to 90%.

“This study highlights the important public health opportunity for the prevention of type 2 diabetes in this high-risk population,” the study authors said.

The prospective cohort study of 4300 women with gestational diabetes found that meeting optimal levels of key modifiable risk factors such as healthy weight, high quality diet, regular physical activity, moderate consumption of alcohol and smoking bans significantly reduced the likelihood of developing type 2 diabetes – and that there was a dose-response relationship.

The researchers analyzed nearly three decades of data from the Nurses’ Health Study II, which included repeated measures of weight and lifestyle factors.

They found that the number of maintained optimal modifiable risk factors was inversely related to the incidence of type 2 diabetes. People with optimal levels of all of these factors were significantly less likely to develop the disease than participants who did not. not these standards.

“Participants who had optimal levels of the five modifiable factors after index pregnancy had a more than 90% lower risk of developing type 2 diabetes compared to those who did not,” the authors wrote.

“Importantly, the lower risk…was evident even in high-risk women who were overweight or obese or had a higher genetic susceptibility.

Although maintaining a healthy BMI is an important consideration, adopting the four additional modifiable factors has resulted in a reduction in disease incidence of up to 60%, even when optimal weight control could not be achieved.

“A key message from the study was that for women with a history of gestational diabetes mellitus, progressively increasing the number of optimal modifiable risk factors was associated with a dose-dependent reduction in the risk of type 2 diabetes, even in those who were overweight or obese,” the authors wrote..

BMJ 2022, online September 21

BMJ 2022, online September 21

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