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Gestational Diabetes as a Risk Factor for Cardiovascular Disease

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Biology of Women’s Heart Health

Part of the book series: Advances in Biochemistry in Health and Disease ((ABHD,volume 26))

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Abstract

Gestational diabetes (GDM), defined as glucose intolerance with first recognition in pregnancy, is one of the most common medical conditions in pregnancy. It is well known that gestational diabetes is associated with a number of obstetric and neonatal complications; however, GDM is also an important risk factor for conditions that are diagnosed far past the postpartum period. One of these, which has become increasingly recognized, is the higher risk of cardiovascular disease among people who have been diagnosed with GDM. Evidence suggests that people with GDM have a twofold higher risk of cardiovascular disease and that this risk is evident within the first decade following pregnancy. As cardiovascular disease is the leading cause of death worldwide, it is imperative that the factors that contribute to cardiovascular disease in women are delineated to inform prevention and treatment strategies. A diagnosis of GDM offers women, clinicians, and policy makers a unique opportunity to implement effective screening and treatment strategies to reduce cardiovascular disease in this population. Much more research is needed to identify the best evidence-based practices for cardiovascular disease protection in this population. Nonetheless, it is essential that people with GDM and their healthcare providers recognize this risk and the importance of continued screening, treatment, and follow-up. This chapter will discuss the relationship between GDM and cardiovascular disease. Specifically, we will review: key highlights regarding GDM epidemiology, diagnosis, and outcomes; potential pathophysiologic mechanisms for the development of cardiovascular disease following GDM; the epidemiology of cardiovascular disease following GDM; and the screening for and prevention of cardiovascular disease following GDM.

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References

  1. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH (2014) Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 103(2):176–185

    Google Scholar 

  2. Garcia-Patterson A, Gich I, Amini SB, Catalano PM, de Leiva A, Corcoy R (2010) Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia 53(3):446–451

    Google Scholar 

  3. Metzger BE, Gabbe SG, Persson B, Buchanan TA et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682

    Google Scholar 

  4. Pillay J, Donovan L, Guitard S, Zakher B, Gates M, Gates A et al (2021) Screening for gestational diabetes: updated evidence report and systematic review for the us preventive services task force. JAMA 326(6):539–562

    Google Scholar 

  5. Diabetes Canada Clinical Practice Guidelines Expert Committee, Feig DS, Berger H, Donovan L, Godbout A, Kader T et al (2018) Diabetes and pregnancy. Can J Diabetes 42(Suppl 1):S255–S282

    Google Scholar 

  6. National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period UK2020. Available from: https://www.nice.org.uk/guidance/ng3

  7. American Diabetes A. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care 44(Suppl 1):S15–S33

    Google Scholar 

  8. Hapo Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002

    Google Scholar 

  9. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B et al (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 361(14):1339–1348

    Google Scholar 

  10. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS et al (2005) Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 352(24):2477–2486

    Google Scholar 

  11. Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373(9677):1773–1779

    Google Scholar 

  12. Lowe WL Jr, Scholtens DM, Lowe LP, Kuang A, Nodzenski M, Talbot O et al (2018) Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 320(10):1005–1016

    Google Scholar 

  13. Kramer CK, Campbell S, Retnakaran R (2019) Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia 62(6):905–914

    Google Scholar 

  14. Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T et al (2021) Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia 64(2):275–287

    Google Scholar 

  15. Pickup JC (2004) Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care 27(3):813–823

    Google Scholar 

  16. Gunderson EP, Quesenberry CP Jr, Jacobs DR Jr, Feng J, Lewis CE, Sidney S (2010) Longitudinal study of prepregnancy cardiometabolic risk factors and subsequent risk of gestational diabetes mellitus: the CARDIA study. Am J Epidemiol 172(10):1131–1143

    Google Scholar 

  17. Quotah OF, Poston L, Flynn AC, White SL (2022) Metabolic profiling of pregnant women with obesity: an exploratory study in women at greater risk of gestational diabetes. Metabolites 12(10)

    Google Scholar 

  18. Retnakaran R, Qi Y, Connelly PW, Sermer M, Hanley AJ, Zinman B (2010) Low adiponectin concentration during pregnancy predicts postpartum insulin resistance, beta cell dysfunction and fasting glycaemia. Diabetologia 53(2):268–276

    Google Scholar 

  19. Oliveira AP, Calderon IM, Costa RA, Roscani MG, Magalhaes CG, Borges VT (2015) Assessment of structural cardiac abnormalities and diastolic function in women with gestational diabetes mellitus. Diab Vasc Dis Res 12(3):175–180

    Google Scholar 

  20. Tobias DK, Stuart JJ, Li S, Chavarro J, Rimm EB, Rich-Edwards J et al (2017) Association of history of gestational diabetes with long-term cardiovascular disease risk in a large prospective cohort of US women. JAMA Intern Med 177(12):1735–1742

    Google Scholar 

  21. Shah BR, Retnakaran R, Booth GL (2008) Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care 31(8):1668–1669

    Google Scholar 

  22. McKenzie-Sampson S, Paradis G, Healy-Profitos J, St-Pierre F, Auger N (2018) Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study. Acta Diabetol 55(4):315–322

    Google Scholar 

  23. You H, Hu J, Liu Y, Luo B, Lei A (2021) Risk of type 2 diabetes mellitus after gestational diabetes mellitus: a systematic review and meta-analysis. Indian J Med Res 154(1):62–77

    Google Scholar 

  24. Tobias DK, Hu FB, Forman JP, Chavarro J, Zhang C (2011) Increased risk of hypertension after gestational diabetes mellitus: findings from a large prospective cohort study. Diabetes Care 34(7):1582–1584

    Google Scholar 

  25. Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J et al (2018) Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: a population-based cohort study. PLoS Med 15(1):e1002488

    Google Scholar 

  26. Retnakaran R, Shah BR (2022) Mediating effect of vascular risk factors underlying the link between gestational diabetes and cardiovascular disease. BMC Med 20(1):389

    Google Scholar 

  27. Kim C, Cheng YJ, Beckles GL (2008) Cardiovascular disease risk profiles in women with histories of gestational diabetes but without current diabetes. Obstet Gynecol 112(4):875–883

    Google Scholar 

  28. Smith G, Louis J, Saade G (2019) Pregnancy and the postpartum period as an opportunity for cardiovascular risk identification and management. Obstet Gynecol 134(4)

    Google Scholar 

  29. Jones EJ, Hernandez TF, Edmonds JK, Edmonds JF, Ferranti EP, Ferranti EP (2019) Continued disparities in postpartum follow-up and screening among women with gestational diabetes and hypertensive disorders of pregnancy: a systematic review (1550-5073 (Electronic))

    Google Scholar 

  30. Carson MP, Frank MI, Keely E (2013) Original research: postpartum testing rates among women with a history of gestational diabetes–systematic review. Prim Care Diabetes 7(3):177–186

    Google Scholar 

  31. Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC (2014) From screening to postpartum follow-up—the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 14(1):41

    Google Scholar 

  32. Keely E, Clark H, Karovitch A, Graham I (2010) Screening for type 2 diabetes following gestational diabetes: family physician and patient perspectives. Can Fam Physician 56(6):558–563

    Google Scholar 

  33. Lie ML, Hayes L, Lewis-Barned NJ, May C, White M, Bell R (2013) Preventing type 2 diabetes after gestational diabetes: women’s experiences and implications for diabetes prevention interventions. Diabet Med 30(8):986–993

    Google Scholar 

  34. Nerenberg KA, Cooke CL, Smith GN, Davidge ST (2021) Optimising women’s cardiovascular health after hypertensive disorders of pregnancy: a translational approach to cardiovascular disease prevention. Can J Cardiol 37(12):2056–2066

    Google Scholar 

  35. Today Study Group, Bjornstad P, Drews KL, Caprio S, Gubitosi-Klug R, Nathan DM et al (2021) Long-term complications in youth-onset type 2 diabetes. N Engl J Med 385(5):416–426

    Google Scholar 

  36. Yamamoto JM, Murphy HR (2023) Treating to target glycaemia in type 2 diabetes pregnancy. Curr Diabetes Rev 19(2):e010222200742

    Google Scholar 

  37. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403

    Google Scholar 

  38. Aroda VR, Christophi CA, Edelstein SL, Zhang P, Herman WH, Barrett-Connor E et al (2015) The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. J Clin Endocrinol Metab 100(4):1646–1653

    Google Scholar 

  39. Hedeager Momsen AM, Hotoft D, Ortenblad L, Friis Lauszus F, Krogh RHA, Lynggaard V et al (2021) Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews. Endocrinol Diabetes Metab 4(3):e00230

    Google Scholar 

  40. Retnakaran M, Viana LV, Kramer CK (2023) Lifestyle intervention for the prevention of type 2 diabetes in women with prior gestational diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 25(5):1196–1202

    Google Scholar 

  41. Martens PJ, Shafer LA, Dean HJ, Sellers EA, Yamamoto J, Ludwig S et al (2016) Breastfeeding initiation associated with reduced incidence of diabetes in mothers and offspring. Obstet Gynecol 128(5):1095–1104

    Google Scholar 

  42. Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D et al (2015) Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med 163(12):889–898

    Google Scholar 

  43. Jager S, Jacobs S, Kroger J, Fritsche A, Schienkiewitz A, Rubin D et al (2014) Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis. Diabetologia 57(7):1355–1365

    Google Scholar 

  44. Butalia S, Donovan L, Savu A, Johnson J, Edwards A, Kaul P (2017) Postpartum diabetes testing rates after gestational diabetes mellitus in Canadian women: a population-based study. Can J Diabetes 41(6):613–620

    Google Scholar 

  45. Forde R, Patelarou EE, Forbes A (2016) The experiences of prepregnancy care for women with type 2 diabetes mellitus: a meta-synthesis. Int J Womens Health 8:691–703

    Google Scholar 

  46. Murphy HR, Temple RC, Ball VE, Roland JM, Steel S, Zill EHR et al (2010) Personal experiences of women with diabetes who do not attend pre-pregnancy care. Diabet Med 27(1):92–100

    Google Scholar 

  47. O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O et al (2022) Pregnancy and reproductive risk factors for cardiovascular disease in women. Circ Res 130(4):652–672

    Google Scholar 

  48. Trussell J (2011) Contraceptive failure in the United States. Contracept 83(5):397–404

    Google Scholar 

  49. Lindley KJ, Bairey Merz CN, Davis MB, Madden T, Park K, Bello NA et al (2021) Contraception and reproductive planning for women with cardiovascular disease: JACC focus seminar 5/5. J Am Coll Cardiol 77(14):1823–1834

    Google Scholar 

  50. World Health Organization (2015) Medical eligibility criteria for contraceptive use 5th ed. Available from: https://www.who.int/publications/i/item/9789241549158

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Author information

Authors and Affiliations

  1. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Jamie L. Benham & Jennifer M. Yamamoto

  2. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Jamie L. Benham

  3. Department of Internal Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Jennifer M. Yamamoto

  4. Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

    Jennifer M. Yamamoto

Authors
  1. Jamie L. Benham
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  2. Jennifer M. Yamamoto
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Correspondence to Jennifer M. Yamamoto .

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Editors and Affiliations

  1. The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada

    Lorrie Kirshenbaum

  2. The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada

    Inna Rabinovich-Nikitin

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Benham, J.L., Yamamoto, J.M. (2023). Gestational Diabetes as a Risk Factor for Cardiovascular Disease. In: Kirshenbaum, L., Rabinovich-Nikitin, I. (eds) Biology of Women’s Heart Health. Advances in Biochemistry in Health and Disease, vol 26. Springer, Cham. https://doi.org/10.1007/978-3-031-39928-2_9

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