Gestational diabetes linked to early atherosclerosis

Women who develop gestational diabetes mellitus (GDM) may be at greater risk for developing early atherosclerosis during midlife, according to a new study in the Journal of the American Heart Association.

Researchers from the Division of Research at Kaiser Permanente Northern California used data from the Coronary Artery Risk Development in Young Adults study. The cohort (n = 898) was composed of women who had no history of diabetes mellitus (DM) or heart disease at baseline (1985-1986), delivered ≥1 infants after the study’s start, had a history of GDM, and had their common carotid intima media thickness (ccIMT) measured between 2005 and 2006. Multivariable linear regression was used to assess associations between GDM and ccIMT, adjusting for race, age, parity, and prepregnancy cardiometabolic risk factors. Mediators such as weight gain, insulin resistance, and blood pressure were also assessed for the 20-year study.

In the cohort, 119 women reported a history of GDM (7.6 per 100 deliveries). The average age was 31 years at last birth and 44 years at ccIMT measurement for both the GDM and non-GDM groups. Women with a history of GDM had a ccIMT measurement that was an average 0.023 mm higher than those with no such history (P = 0.029). However prepregnancy body mass index attenuated the difference to 0.016 mm (P = 0.109). In the 777 women with no subsequent history of DM or metabolic syndrome, the mean ccIMT was also an average 0.023mm higher in women with a history of GDM than those without such history, when controlled for race, age, parity, and pre-pregnancy BMI (0.784 vs 0.761, P = 0.039). Adding prepregnancy insulin resistance index resulted in a minimal impact on the adjusted mean net ccIMT difference (0.22 mm). In the 121 women who developed DM or a metabolic syndrome, the average ccIMT did not differ by GDM status.

The researchers concluded that a history of GDM may serve as a marker for early atherosclerosis in women who do not subsequently develop DM or a metabolic syndrome.

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