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Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study

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Abstract

Aims

The risk of cardiovascular disease in women with gestational diabetes is poorly understood. We sought to determine whether gestational diabetes increases the risk of cardiovascular disease more than two decades after pregnancy.

Methods

We carried out a retrospective cohort study of 1,070,667 women who delivered infants in hospitals within Quebec, Canada, between 1989 and 2013. We followed 67,356 women with gestational diabetes and 1,003,311 without gestational diabetes for a maximum of 25.2 years after the index delivery. The main outcome measures were hospitalization for ischemic heart disease, myocardial infarction, coronary angioplasty, coronary artery bypass graft, and other cardiovascular disorders. We used Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) comparing women with gestational diabetes to no gestational diabetes, adjusted for age, parity, socioeconomic deprivation, time period, and preeclampsia.

Results

Women with gestational diabetes had a higher cumulative incidence of hospitalization for cardiovascular disease 25 years after delivery (190.8 per 1000 women) compared with no gestational diabetes (117.8 per 1000 women). Gestational diabetes was associated with a higher risk of ischemic heart disease (HR 1.23, 95% CI 1.12–1.36), myocardial infarction (HR 2.14, 95% CI 1.15–2.47), coronary angioplasty (HR 2.23, 95% CI 1.87–2.65), and coronary artery bypass graft (HR 3.16, 95% CI 2.24–4.47).

Conclusions

In this population of pregnant women, gestational diabetes was associated with an increased risk of heart disease 25 years after delivery. Women with gestational diabetes may merit closer monitoring for cardiovascular disease prevention after pregnancy.

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Acknowledgements

The authors thank Aimina Ayoub for assistance with manuscript revision.

Funding

This work was supported by the Canadian Institutes of Health Research (Grant Number MOP-130452). SMS was supported by a Young Professionals Award from the Quebec Heart Failure Society and Servier Canada Inc.; and NA by a career award from the Fonds de recherche du Québec-Santé (Grant Number 34695).

Author information

Authors and Affiliations

  1. University of Montreal Hospital Research Centre, Montreal, QC, Canada

    Safyer McKenzie-Sampson, Jessica Healy-Profitós & Nathalie Auger

  2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada

    Safyer McKenzie-Sampson, Gilles Paradis & Nathalie Auger

  3. Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada

    Safyer McKenzie-Sampson, Gilles Paradis, Jessica Healy-Profitós & Nathalie Auger

  4. Faculty of Medicine, McGill University, Montreal, QC, Canada

    Frédérique St-Pierre

Authors
  1. Safyer McKenzie-Sampson
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  2. Gilles Paradis
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  3. Jessica Healy-Profitós
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  4. Frédérique St-Pierre
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  5. Nathalie Auger
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Corresponding author

Correspondence to Nathalie Auger.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The research ethics committee of the University of Montreal Hospital Centre waived ethics review as this study complied with the Declaration of Helsinki and the Tricouncil Policy Statement for ethical conduct of research involving humans in Canada.

Informed consent

The data were anonymous and informed consent was not needed for this study.

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Managed by Massimo Porta.

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McKenzie-Sampson, S., Paradis, G., Healy-Profitós, J. et al. Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study. Acta Diabetol 55, 315–322 (2018). https://doi.org/10.1007/s00592-017-1099-2

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  • DOI: https://doi.org/10.1007/s00592-017-1099-2

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