Pregnancy complications and future type 2 diabetes risk

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New research has revealed that postmenopausal women with a history of gestational diabetes and adverse pregnancy outcomes face an increased risk of developing type 2 diabetes, emphasizing the need for preventive measures.

Pregnancy complications and future type 2 diabetes risk | Image Credit: © Siam - © Siam - stock.adobe.com.

Pregnancy complications and future type 2 diabetes risk | Image Credit: © Siam - © Siam - stock.adobe.com.

Future type 2 diabetes mellitus (T2D) risk is increased in postmenopausal women with a gestational diabetes mellitus (GDM) history, hypertensive disorders of pregnancy (HDP), or delivering infants with a high birth weight (HBW), according to a recent study published in the American Journal of Obstetrics & Gynecology.

Takeaways

  1. Postmenopausal women with a history of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), or delivering infants with high birth weight (HBW) face an elevated risk of future type 2 diabetes mellitus (T2D).
  2. Adverse pregnancy outcomes (APOs) such as GDM, HDP, preterm birth (PTB), and abnormal birth weight can lead to changes in lipid profile and insulin resistance. These APOs may heighten existing metabolic risks, increasing the overall risk of chronic diseases.
  3. From 2017 to 2020, about 24% of US adults aged 65 years and older had a T2D diagnosis, significantly impacting quality of life. Women, in particular, face more complications and mortality associated with T2D.
  4. While the association between GDM and T2D is established, there is limited information on how other APOs impact T2D risk. The study focused on evaluating this association in women with GDM using data from the Women’s Health Initiative.
  5. Lower education levels, family income, healthy eating scores, physical activity, and higher parity and body mass index were associated with at least one APO. The risk of T2D increased with any APO, and GDM had the highest odds ratio (OR). The number of APOs also correlated with increased T2D risk, emphasizing the importance of considering APOs as significant risk factors for T2D in postmenopausal women.

Pregnancy leads to significant changes in lipid profile and insulin resistance, and adverse pregnancy outcomes (APOs) included GDM, HDP, preterm birth (PTB), and delivering an infant with an abnormal birth weight. These APOs may heighten existing metabolic risks and increase the risks of chronic diseases.

From 2017 to 2020, approximately 24% of US adults aged 65 years and older had a T2D diagnosis. T2D can significantly impact quality of life, and women more often face associated complications and mortality. 

Although an association between GDM and T2D has been established, there is little information about how other APOs impact T2D risk. Investigators conducted a study to evaluate this association in women with GDM.

Data was obtained from the Women’s Health Initiative, a nationwide study including 3 clinical trials, across which there were 161,808 women aged 50 to 79 years from 1993 to 1998. APO history was not evaluated at baseline, but the 79,104 women still enrolled in 2017 were sent a survey to collect data on APO history, Seventy-four percent of these women responded to the survey.

APOs evaluated include PTB, preeclampsia, gestational hypertension (GH), GDM, low birth weight (LBW), and HBW. T2D was the primary outcome of the analysis. At baseline, this outcome was determined by responses to the question, “Did a doctor ever say that you had sugar diabetes or high blood sugar when you were not pregnant?”

Self-reports through annually mailed questionnaires through March 2021 were used to identify incident T2D diagnosis. Patients reported if they were ever prescribed pills or insulin shots for diabetes. Covariates included race and ethnicity, age, education, annual family income, smoking, diet, alcohol intake, breastfeeding, parity, age at first birth, menarche, and menopause.

There were 49,717 participants included in the final analysis, 21.9% of whom presented with newly diagnosed and treated T2D during follow-up and 28.8% reported a history of 1 or more APO. GDM, HBW, HDP, PTB, and LBW were reported in 1.9%, 5.8%, 6.3%, 14.7%, and 12.5% of patients, respectively.

Lower levels of education, family income, Alternative Healthy Eating Index-2010 scores, physical activity, and age at menarche, as well as higher parity and body mass index, were reported in patients with at least 1 APO. These patients were also more often non-White, current smokers, had a greater frequency of irregular periods, and had a family history of diabetes mellitus.

The risk of T2D was increased in patients with any APO, with an odds ratio (OR) of 1.19 after adjustment for covariates. However, PTB and LBW were not significantly associated with T2D risk, with ORs of 1.06 and 1.02, respectively. 

A history of more APOs was associated with increased risks, as 1 to 2 APOs had an OR of 1.13 and over 2 APOs an OR of 1.55. GDM had an OR of 2.65 for T2D, making it greater than any other APO. Women with both GDM and HBW or with GDM and PTB had an increased risk compared to women with GDM only, with ORs of 2.23, 3.41, and 2.04, respectively.

Investigators observed an impact from parity on the association between GDM and T2D. The association had an OR of 1.52 among women with 0 to 2 parities, vs 2.54 among women with more than 2 parities. Among non-Hispanic Black, non-Hispanic White, Hispanic, and individuals of other races, the association between APO and T2D had ORs of 1.53, 1.19, 0.93, and 1.18, respectively.

These results indicated APOs increase the risk of T2D in women with GDM. Investigators concluded these APOs should be considered important risk factors for T2D among postmenopausal women.

Reference

Zhu K, Wactawski-Wende J, Mendola P, et al. Adverse pregnancy outcomes and risk of type 2 diabetes in postmenopausal women. Am J Obstet Gynecol. 2024;230:93.e1-19. doi:10.1016/j.ajog.2023.07.030

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