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. 2018 Jan 16;15(1):e1002488.
doi: 10.1371/journal.pmed.1002488. eCollection 2018 Jan.

Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study

Barbara Daly  1 , Konstantinos A Toulis  2 , Neil Thomas  2 , Krishna Gokhale  2 , James Martin  2 , Jonathan Webber  3 , Deepi Keerthy  2 , Kate Jolly  2 , Ponnusamy Saravanan  4 , Krishnarajah Nirantharakumar  2
Affiliations

Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study

Barbara Daly et al. PLoS Med. .

Erratum in

Abstract

Background: Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease.

Methods and findings: We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31-26.34) and hypertension (IRR = 1.85; 95% CI 1.59-2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37-5.66), and for cerebrovascular disease 0.95 (95% CI 0.51-1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease.

Conclusions: Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.

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Conflict of interest statement

The authors have declared that no competing interest exist.

Figures

Fig 1
Fig 1. Flow diagram of the source population, women with gestation diabetes mellitus (GDM), and matched controls, including the proportion of women followed up in each group.
Fig 2
Fig 2. Cumulative incidence of diabetes, hypertension, IHD, and stroke or TIA for women with GDM and control women.
The analyses for diabetes and hypertension are adjusted for age, Townsend quintile, BMI, and smoking. The analyses for IHD and stroke or TIA are adjusted for the above covariates, prescribed lipid-lowering medication, and hypertension. BMI, body mass index; GDM, gestational diabetes mellitus; IHD, ischemic heart disease; TIA, transient ischemic attack.
See this image and copyright information in PMC

Comment in

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