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Diabetes Care. 2018 Jul;41(7):1378-1384. doi: 10.2337/dc17-2629. Epub 2018 May 4.

Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy.

Author information

1
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
2
Department of Nutritional Sciences, School of Health Professions, Rutgers University, Newark, NJ.
3
Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark.
4
Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark.
5
The Danish Diabetes Academy, Odense, Denmark.
6
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
7
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
8
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
9
Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
10
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
11
Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
12
Cardiovascular and Metabolic Disease Translational Medicine Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden.
13
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
14
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD zhangcu@mail.nih.gov.

Abstract

OBJECTIVE:

To examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy.

RESEARCH DESIGN AND METHODS:

In the Diabetes & Women's Health (DWH) study (2012-2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived.

RESULTS:

Compared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR.

CONCLUSIONS:

Women who develop GDM in pregnancy were more likely to show increased eGFR levels 9-16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.

PMID:
29728364
PMCID:
PMC6014536
DOI:
10.2337/dc17-2629
[Indexed for MEDLINE]
Free PMC Article

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