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JAMA Intern Med. 2017 Dec 1;177(12):1735-1742. doi: 10.1001/jamainternmed.2017.2790.

Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women.

Tobias DK1,2, Stuart JJ3,4, Li S5, Chavarro J2,3,6, Rimm EB2,3,6, Rich-Edwards J3,4, Hu FB2,3,6, Manson JE1,3,4, Zhang C5,7.

Author information

1
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
2
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
3
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
4
Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
5
Boston University School of Medicine, Boston, Massachusetts.
6
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
7
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland.

Abstract

Importance:

Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors including body weight and lifestyle.

Objective:

To prospectively evaluate history of GD in relation to incident CVD risk.

Design, Setting, and Participants:

The Nurses' Health Study II (NHS II) is an observational cohort study of US female nurses established in 1989, with ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. Multivariable Cox models estimated the hazard ratio (HR) and 95% CI for CVD risk. We included 89 479 women who reported at least 1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for more than 90% of eligible participants.

Exposures:

History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years.

Main Outcomes and Measures:

We observed 1161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records.

Results:

Participants had a mean (SD) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71).

Conclusions and Relevance:

Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.

PMID:
29049820
PMCID:
PMC5820722
DOI:
10.1001/jamainternmed.2017.2790
[Indexed for MEDLINE]
Free PMC Article

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