Cardiovascular function in women with previous gestational diabetes mellitus and dysglycemia at 5 months postpartum

Abstract

Objective: To examine the cardiovascular profile of women at 5 months postpartum who developed gestational diabetes mellitus (GDM), and to determine whether this profile differs between those with dysglycemia and those who are normoglycemic.

Methods: A postnatal follow-up clinic was attended by 770 women who developed GDM. At this visit, we recorded maternal demographic characteristics, obstetric and medical history, details regarding pregnancy outcome, weight, height, upper arm and waist circumference, lipid profile and hemoglobin A1c. We also performed a 75-g oral glucose tolerance test and extensive cardiovascular assessment, including Doppler measurement of the ophthalmic arteries, carotid-to-femoral pulse-wave velocity and echocardiography. Multivariable logistic regression was performed to assess which factors were associated with dysglycemia. Calibration of the model was assessed using the Hosmer-Lemeshow test and its discrimination was evaluated using receiver-operating-characteristics (ROC) curve analysis.

Results: At a median of 5-months postpartum, more than half of the 770 women had dysglycemia, including 368 (47.8%) with prediabetes and 34 (4.4%) with Type-2 diabetes mellitus. In the multivariable analysis, the risk factors for dysglycemia were Black ethnicity (adjusted odds ratio (aOR), 2.61 (95% CI, 1.71-3.98)), South Asian ethnicity (aOR, 1.81 (95% CI, 1.18-2.78)), East Asian ethnicity (aOR, 2.46 (95% CI, 1.35-4.48)), mixed ethnicity (aOR, 2.68 (95% CI, 1.19-6.04)), diagnosis of GDM < 24 weeks' gestation (aOR, 2.15 (95% CI, 1.34-3.45)), treatment of GDM with insulin (aOR, 1.96; 95% CI, 1.26-3.05), postnatal body mass index (BMI) (aOR, 1.47 (95% CI, 1.05-2.06)), central diastolic blood pressure (aOR, 1.42 (95% CI, 1.01-2.00)), mitral peak early diastolic flow velocity to early mitral annulus diastolic velocity ratio (E/e') (aOR, 1.31 (95% CI, 1.00-1.80)) and total peripheral resistance (aOR, 0.61 (95% CI, 0.44-0.86)). The calibration of the model was P = 0.397 and the discrimination was indicated by an area under the ROC curve of 0.707 (95% CI, 0.670-0.743).

Conclusion: These findings suggest that women who developed GDM and had persistent dysglycemia at 5 months postpartum have a distinct phenotype which is characterized by increased BMI and signs of cardiovascular strain, including elevated central blood pressure and reduced left ventricular relaxation. These findings suggest that, among women who developed GDM, those with persistent dysglycemia appear to be at increased cardiovascular risk. Further studies are needed to assess whether targeting weight loss with lifestyle or pharmacological interventions can reduce the risk not only for Type-2 diabetes mellitus, but also for later cardiovascular disease. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: diabetes; dysglycemia; echocardiography; gestational diabetes; ophthalmic artery Doppler; prediabetes; pulse‐wave velocity.