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J Am Heart Assoc. 2019 Nov 5;8(21):e014231. doi: 10.1161/JAHA.119.014231. Epub 2019 Oct 28.

Screening Glucose Challenge Test in Pregnancy Can Identify Women With an Adverse Postpartum Cardiovascular Risk Factor Profile: Implications for Cardiovascular Risk Reduction.

Author information

1
Leadership Sinai Centre for Diabetes Mount Sinai Hospital Toronto Canada.
2
Division of Endocrinology University of Toronto Canada.
3
Lunenfeld-Tanenbaum Research Institute Mount Sinai Hospital Toronto Canada.
4
Department of Nutritional Sciences University of Toronto Canada.
5
Keenan Research Centre for Biomedical Science of St. Michael's Hospital Toronto Canada.
6
Department of Laboratory Medicine and Pathobiology University of Toronto Canada.
7
Department of Obstetrics and Gynecology Mount Sinai Hospital Toronto Canada.

Abstract

Background The 1-hour glucose challenge test (GCT) is routinely performed in pregnancy to screen for gestational diabetes mellitus. Remarkably, it has recently emerged that the GCT can also predict a woman's future risk of cardiovascular disease, although the mechanistic basis of this relationship is unclear. In this context we hypothesized that a higher GCT may identify women with an otherwise unrecognized adverse cardiovascular phenotype. Thus, we sought to evaluate the relationship between the antepartum GCT and subsequent postpartum cardiovascular risk factor profile. Methods and Results In this study 503 women completed a screening GCT in late second trimester and then underwent cardiometabolic characterization at 3 months postpartum, whereupon traditional (blood pressure, glucose, lipids) and nontraditional (apolipoprotein B, C-reactive protein, adiponectin) cardiovascular risk factors were compared across GCT tertiles. At 3 months postpartum, each of the following risk factors progressively worsened from the lowest to middle to highest GCT tertile: fasting glucose (P=0.0002), 2-hour glucose (P<0.0001), total cholesterol:high-density lipoprotein cholesterol (P=0.0004), high-density lipoprotein cholesterol (P=0.004), triglycerides (P=0.001), apolipoprotein B (P=0.001), and adiponectin (P=0.02). On multiple linear regression analyses, the GCT emerged as a significant independent predictor of higher fasting glucose (P=0.0006), 2-hour glucose (P<0.0001), total cholesterol: high-density lipoprotein cholesterol (P=0.0004), triglycerides (P=0.001), low-density lipoprotein cholesterol (P=0.01), and apolipoprotein B (P=0.004) and of lower high-density lipoprotein cholesterol (P=0.02) and adiponectin (P=0.0099). Moreover, these independent associations persisted after excluding women who had gestational diabetes mellitus. Conclusions The antepartum GCT can identify women with an adverse underlying cardiovascular risk factor phenotype.

KEYWORDS:

cardiovascular disease; glucose challenge test; lipids; risk factors; women

PMID:
31657272
DOI:
10.1161/JAHA.119.014231
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