Gestational Diabetes May Indicate Early Atherosclerosis

A history of gestational diabetes could be a risk factor for women later developing heart disease, researchers suggested.

Researchers found that gestational diabetes increased a woman’s risk of developing early atherosclerosis before developing type 2 diabetes or the metabolic syndrome. In reporting their findings in the Journal of the American Heart Association, the authors suggested that gestational diabetes may be a marker for early atherosclerosis.

Pertinent Points

- A history of gestational diabetes could be a marker for the development of early atherosclerosis in women without type 2 diabetes or metabolic syndrome.

- The study followed nearly 900 women for 20 years and tracked the carotid artery intima-media thickness.

"Pregnancy has been under-recognized as an important time period that can signal a woman's greater risk for future heart disease,” said Erica P. Gunderson, PhD, MS, MPH, the study’s lead author and senior research scientist in the Division of Research at Kaiser Permanente Northern California in Oakland, Calif.

Of the 2,787 women enrolled in the Coronary Artery Risk Development in Young Adults study, all 18 to 30 years old, the researchers included 898 women, 18 to 30 years old, who did not have type 2 diabetes or heart disease at baseline. All of these 898 women later had one or more births and reported their gestational diabetes status.

Over the 20-year study, the women were periodically tested for diabetes and metabolic conditions, including before and after their pregnancies. During the study, 13% (119 women) reported having gestational diabetes.

By measuring common carotid intima media thickness, the researchers were able to spot a difference between the women who had gestational diabetes and those who did not. Among the women in whom diabetes or the metabolic syndrome did not develop during the 20-year follow up, the researchers found that the average carotid artery intima-media thickness was 0.023 mm larger in those who had gestational diabetes compared with those who didn't (P=0.029). This difference between the groups was not linked to obesity or elevated glucose levels before pregnancy.

The study controlled for age; race; number of births; pre-pregnancy body mass index; blood pressure; and fasting blood glucose, insulin, and lipid levels.

"It's a shift in thinking about how to identify a subgroup at risk for atherosclerosis early," Gunderson said. "The concept that reproductive complications unmask future disease risk is a more recent focus."