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Risk of cardiovascular events after gestational diabetes: a retrospective population study

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Abstract

Aims

To investigate whether the risk for post-partum cardiovascular diseases (CVD) is driven by gestational diabetes (GDM), by GDM-related risk factors and/or by pre-gestational (Pre-GD) or post-gestational diabetes (Post-GD).

Methods

Women delivering in Tuscany, Italy in years 2010–2012 (n = 74,720), were identified from certificates of care at delivery and further identified as affected with GDM, Pre-GD or Post-GD through regional administrative databases. Women with GDM, Pre-GD or Post-GD were retrospectively evaluated for risk of post-partum hospitalizations for CVD (myocardial infarction or stroke; n = 728) across years 2013–2021, comparing women with different forms of diabetes to those without diabetes. Risk of CVD was assessed as odds ratio (OR 95% CI), after logistic multivariate models, considering all recorded pre-gestational characteristics as covariates.

Results

The adjusted OR (aOR) for post-partum CVD hospitalizations was not significantly related to GDM itself (aOR: 0.85; 0.64–1.12; p = ns), but increased in women with Pre-GD (aOR: 2.02; 1.09–3.71; p = 0.024) and Post-GD, associated or not to prior GDM (aOR; 4.21; 2.45–7.23 and respectively aOR: 3.80; 2.38–6.05; p < 0.0001 for both). In presence of pre-pregnancy maternal obesity (BMI ≥ 30 kg/m2) the aOR of CVD approximatively doubled (aOR: 1.90; 1.51–2.40); p < 0.0001, independently of GDM and of Post-GD. The adjusted risk of CVD was lower among employed women (aOR: 0.83; 0.70–0.99); p = 0.04 and significantly higher in presence of poorer education levels (aOR: 1.32; 1.11–1.57); p < 0.0001.

Conclusion

In this population the risk of post-partum CVD was driven by Pre- and Post-GD, not by GDM alone. Pre-gestational obesity represented a major independent risk factor for post-partum CVD.

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Data availability

On motivated request, the access to data can be obtained by the Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy.

References

  1. Vounzoulaki E, Khunti K, Abner SC et al (2020) Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 369:1361. https://doi.org/10.1136/bmj.m1361

    Article  Google Scholar 

  2. Juan J, Sun Y, Wei Y et al (2022) Progression to type 2 diabetes mellitus after gestational diabetes mellitus diagnosed by IADPSG criteria: systematic review and meta-analysis. Front Endocrinol (Lausanne) 13:1012244. https://doi.org/10.3389/fendo.2022.1012244

    Article  PubMed  Google Scholar 

  3. Retnakaran R (2009) Glucose tolerance status in pregnancy: a window to the future risk of diabetes and cardiovascular disease in young women. Curr Diabetes Rev 5(4):239–244. https://doi.org/10.2174/157339909789804378

    Article  CAS  PubMed  Google Scholar 

  4. Xie W, Wang Y, Xiao S et al (2022) Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ 378:e070244. https://doi.org/10.1136/bmj-2022-070244

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yu Y, Soohoo M, Sørensen HT, Li J, Arah OA (2022) Gestational diabetes mellitus and the risks of overall and type-specific cardiovascular diseases: a population- and sibling-matched cohort study. Diabetes Care 45(1):151–159. https://doi.org/10.2337/dc21-1018

    Article  PubMed  Google Scholar 

  6. https://www.salute.gov.it/imgs/C_17_pubblicazioni_2585_allegato.pdf (last accessed January 10, 2024)

  7. Buja A, Gini R, Visca M, Damiani G, Federico B, Francesconi P et al (2013) Valore Project Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study Valore Project. BMC Public Health 13:504. https://doi.org/10.1186/1471-2458-13-504

    Article  PubMed  PubMed Central  Google Scholar 

  8. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682. https://doi.org/10.2337/dc09-1848

    Article  CAS  PubMed Central  Google Scholar 

  9. Di Cianni G, Gualdani E, Berni C et al (2017) Screening for gestational diabetes in Tuscany, Italy. A population study. Diabetes Res Clin Pract 132:149–156. https://doi.org/10.1016/j.diabres.2017.08.003

    Article  PubMed  Google Scholar 

  10. Gini R, Francesconi P, Mazzaglia G et al (2013) Chronic disease prevalence from Italian administrative databases in the VALORE project: a validation through comparison of population estimates with general practice databases and national survey. BMC Public Health 13:15. https://doi.org/10.1186/1471-2458-13-15

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fadl H, Magnuson A, Östlund I, Montgomery S, Hanson U, Schwarcz E (2014) Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study. BJOG 121(12):1530–1536. https://doi.org/10.1111/1471-0528.12754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Retnakaran R, Shah BR (2017) Role of type 2 diabetes in determining retinal, renal, and cardiovascular outcomes in women with previous gestational diabetes mellitus. Diabetes Care 40:101–108. https://doi.org/10.2337/dc16-1400

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Goueslard K, Cottenet J, Mariet AS et al (2016) Early cardiovascular events in women with a history of gestational diabetes mellitus. Cardiovasc Diabetol 15:15. https://doi.org/10.1186/s12933-016-0338-0

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tobias DK, Stuart JJ, Li S et al (2017) Association of history of gestational diabetes with long-term cardiovascular disease risk in a large prospective cohort of US women. JAMA Intern Med 177(12):1735–1742. https://doi.org/10.1001/jamainternmed.2017.2790

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sun J, Kim GR, Lee SJ, Kim HC (2021) Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events. Sci Rep 11(1):21140. https://doi.org/10.1038/s41598-021-99993-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Motevalizadeh E, Díaz-López A, Martín F, Basora J, Arija V (2023) Association of parity with insulin resistance early in pregnant women ECLIPSES study. J Clin Endocrinol Metab. https://doi.org/10.1210/clinem/dgad594

    Article  Google Scholar 

  18. Seghieri G, De Bellis A, Anichini R, Alviggi L, Franconi F, Breschi MC (2005) Does parity increase insulin resistance during pregnancy? Diabet Med 22(11):1574–1580. https://doi.org/10.1111/j.1464-5491.2005.01693.x

    Article  CAS  PubMed  Google Scholar 

  19. Giuliani C, Sciacca L, Biase ND et al (2022) Gestational diabetes mellitus pregnancy by pregnancy: early, late and nonrecurrent GDM. Diabetes Res Clin Pract 188:109911. https://doi.org/10.1016/j.diabres.2022.109911

    Article  CAS  PubMed  Google Scholar 

  20. Parikh NI, Cnattingius S, Dickman PW et al (2010) Parity and risk of later-life maternal cardiovascular disease. Am Heart J 159(2):215-221.e6. https://doi.org/10.1016/j.ahj.2009.11.017

    Article  PubMed  Google Scholar 

  21. Dennison RA, Chen ES, Green ME et al (2021) The absolute and relative risk of type 2 diabetes after gestational diabetes: a systematic review and meta-analysis of 129 studies. Diabetes Res Clin Pract 171:108625. https://doi.org/10.1016/j.diabres.2020.108625

    Article  PubMed  Google Scholar 

  22. Khan SS, Ning H, Wilkins JT et al (2018) Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol 3:280–287. https://doi.org/10.1001/jamacardio.2018.0022

    Article  PubMed  PubMed Central  Google Scholar 

  23. Choi S, Kim K, Kim SM et al (2018) Association of obesity or weight change with coronary heart disease among young adults in South Korea. JAMA Intern Med 178:1060–1068. https://doi.org/10.1001/jamainternmed.2018.2310

    Article  PubMed  PubMed Central  Google Scholar 

  24. van Dis I, Kromhout D, Geleijnse JM, Boer JM, Verschuren WM (2009) Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20,000 Dutch men and women aged 20–65 years. Eur J Cardiovasc Prev Rehabil 16(6):729–734. https://doi.org/10.1097/HJR.0b013e328331dfc0

    Article  PubMed  Google Scholar 

  25. Dikaiou P, Björck L, Adiels M et al (2021) Obesity, overweight and risk for cardiovascular disease and mortality in young women. Eur J Prev Cardiol 28(12):1351–1359. https://doi.org/10.1177/2047487320908983

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141, Florence, Italy

    Giuseppe Seghieri, Elisa Gualdani & Paolo Francesconi

  2. National Laboratory of Sex Gender Medicine, National Institute of Biostructures and Biosystems, Sassari, Italy

    Ilaria Campesi & Flavia Franconi

  3. Department of Biomedical Science, University of Sassari, Sassari, Italy

    Ilaria Campesi

  4. Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy

    Graziano Di Cianni

Authors
  1. Giuseppe Seghieri
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  2. Elisa Gualdani
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  3. Ilaria Campesi
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  4. Flavia Franconi
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  5. Paolo Francesconi
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  6. Graziano Di Cianni
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Contributions

GS wrote the final draft of manuscript with input from all co-authors. EG and GS checked the accuracy of  data and led the statistical analysis. FF, IC, PF, GS and GDC participated in the conception and design of the study. GS, PF and GDC participated in the interpretation of data. All Authors approved the definitive version. GS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Guarantor

Giuseppe Seghieri.

Guarantor’s statement

As the guarantor of this work, Giuseppe Seghieri had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Giuseppe Seghieri.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Ethical Standard Statement

All Authors declare that this study has been conducted in accordance with the Declaration of Helsinki and in accordance with the ethical standards of the responsable committe on human experimentation (institutional and national).  Due to the study design and the anonymous by design database, based on Italian regulations, the signature of informed consent was not required.

Informed consent

Each patient was assigned a unique identifier that was the same for all administrative databases. This identifier does not allow the disclosure of the patient’s identity and other sensitive data. Therefore, no informed consent was required from all patients for being included in the study.

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Seghieri, G., Gualdani, E., Campesi, I. et al. Risk of cardiovascular events after gestational diabetes: a retrospective population study. Acta Diabetol (2024). https://doi.org/10.1007/s00592-024-02297-y

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