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Association of endometrial hyperplasia and cancer with a history of gestational diabetes

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Abstract

Purpose

Excess circulating insulin may contribute to endometrial cancer (EC) development; studies suggest increased risk of EC associated with type 2 diabetes. We investigated whether gestational diabetes is associated with increased risk of EC and its precursor, endometrial hyperplasia (EH).

Methods

We conducted a population-based, case–control study of women in Washington State. Cases were women with a hospital discharge record indicating the presence of EH/EC who could be linked to a prior delivery hospitalization or birth record from 1987 to 2013 (n = 593). Controls were randomly selected from remaining deliveries, frequency matched 10:1 on delivery year and maternal age at delivery (n = 5,743). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results

After adjustment for race/ethnicity, maternal age at delivery, and delivery year, EH/EC was associated with a history of gestational diabetes (OR 1.73, 95% CI 1.27–2.35). This association was present for both EH and EC (OR 1.61, 95% CI 1.00–2.60 and OR 1.80, 95% CI 1.22–2.65, respectively). After adjustment for prepregnancy body mass index, the OR for EH/EC was attenuated and became statistically non-significant (OR 1.22, 95% CI 0.87–1.72), except in women <50 years old at the time of case ascertainment (OR 1.49, 95% CI 1.00–2.20). Associations were slightly stronger for EC than EH.

Conclusions

We observed an association between EH/EC and a history of gestational diabetes specific to younger women. Future studies focusing on the relationships between gestational diabetes, obesity, and EC, including age at diagnosis, are warranted.

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Acknowledgements

We would like to thank the Washington State Department of Health for data access, and Mr. Bill O‘Brien for data management and programming.

Funding

P.D.W. was funded by the following grants: (1) U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Grant #T76MC00011; (2) National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Reproductive, Perinatal, and Pediatric Epidemiology Training Grant #T32HD052462. The funding sources had no role in this analysis.

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Authors and Affiliations

  1. Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building, F-262, Box 357660, Seattle, WA, 98195-7236, USA

    Paige D. Wartko, Tiffany L. Beck, Susan D. Reed, Beth A. Mueller & Stephen E. Hawes

  2. Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA

    Tiffany L. Beck & Susan D. Reed

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  1. Paige D. Wartko
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Correspondence to Paige D. Wartko.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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We did not obtain informed consent from participants because it is not necessary for a secondary data analysis of de-identified data.

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Wartko, P.D., Beck, T.L., Reed, S.D. et al. Association of endometrial hyperplasia and cancer with a history of gestational diabetes. Cancer Causes Control 28, 819–828 (2017). https://doi.org/10.1007/s10552-017-0908-9

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