Gestational diabetes and risk of cardiovascular disease: a scoping review

Abstract

Background: Gestational diabetes mellitus is associated with an increased risk of incident type 2 diabetes and has deleterious effects on other cardiovascular risk factors. However, the effect of gestational diabetes on the risk of cardiovascular disease remains unclear. We conducted a scoping review of the literature to examine the association between these 2 conditions.

Methods: We systematically searched the PubMed and Embase databases for studies examining the association between gestational diabetes and cardiovascular disease. We restricted our search to studies involving humans that were published in English or French. Outcomes of interest included acute coronary syndromes, angina, arrhythmia, coronary artery disease, heart failure, myocardial infarction, stroke, and composite end points with these outcomes.

Results: A total of 11 publications (3 cohort studies [1 published as an abstract], 2 cross-sectional studies, 1 case-control study [published as an abstract], 4 narrative reviews, and 1 editorial) met our inclusion criteria. The 2 cohort studies published as full manuscripts were conducted in overlapping populations. The included studies reported a range of adjusted relative risks for incident cardiovascular disease, from not significant to 1.85 (95% confidence interval [CI] 1.21 to 2.82). Adjustment for subsequent type 2 diabetes mellitus attenuated the effects but with wide 95% CIs that spanned unity (range 1.13 [95% CI 0.67 to 1.89] to 1.56 [95% CI 1.00 to 2.43]).

Interpretation: Available data suggest that gestational diabetes is associated with an increased risk of cardiovascular disease. However, these data are limited, and evidence regarding this association independent of the increased risk due to subsequent type 2 diabetes and other risk factors for cardiovascular disease remains inconclusive.

Figure 1

PRISMA flow diagram describing the systematic literature search for studies examining the association between gestational diabetes mellitus and cardiovascular disease.