Long-Term Maternal Metabolic and Cardiovascular Phenotypes after a Pregnancy Complicated by Mild Gestational Diabetes Mellitus or Obesity

Authors

Ashley N Battarbee
Lisa Mele
Mark B Landon
Michael W Varner
Brian M Casey
Uma M Reddy
Ronald J Wapner
Dwight J Rouse
John M Thorp
Edward K Chien
George Saade
Beth A Plunkett
Sean C Blackwell

Publication Date

4-1-2023

Journal

American Journal of Perinatology

Abstract

Objective:

To evaluate the association of mild gestational diabetes (GDM) and obesity with metabolic and cardiovascular markers 5-10 years after pregnancy.

Study Design:

This was a secondary analysis of 5-10 year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/HOMA-IR, and cardiovascular markers VEGF, VCAM-1, CD40L, GDF-15, and ST-2. Multivariable linear regression estimated the association of GDM and obesity with biomarkers.

Results:

Of 951 participants in the parent study, 642(68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences −0.24, 95%CI −0.36–−0.12 and −0.15, 95%CI −0.28–−0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference −0.11, 95%CI −0.19–−0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference −0.42, 95%CI −0.52–−0.32), but not other biomarkers.

Conclusion:

Five to ten years after delivery, prior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction.

Keywords

cardiovascular disease, diabetes, gestational diabetes, obesity, pregnancy