Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis

• Published in: Diabetic medicine Vol. 32; no. 2; pp. 164 - 173
• Main Authors: Kaul, P., Savu, A., Nerenberg, K. A., Donovan, L. E., Chik, C. L., Ryan, E. A., Johnson, J. A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-02-2015; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Alberta - epidemiology; Birth weight; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Chronic illnesses; Cohort Studies; Cross-Sectional Studies; Diabetes; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Diabetes, Gestational - physiopathology; Female; Humans; Hypertension; Hypertension - epidemiology; Hypertension - etiology; Incidence; Longitudinal Studies; Maternal Nutritional Physiological Phenomena; Middle Aged; Overweight - complications; Overweight - physiopathology; Pregnancy; Pregnancy Complications - physiopathology; Registries; Retrospective Studies; Risk Factors; Womens health; Young Adult; Alberta; Canada
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12635

Aims
To examine the association between gestational diabetes mellitus (GDM) and high maternal weight and the risk of development of chronic disease.
Methods
Women with singleton deliveries between April 1999 and March 2010 in Alberta, Canada, were categorized according to pre‐pregnancy weight (overweight ≥ 91 kg) and GDM status. Obstetric and neonatal outcomes, as well as the long‐term incidence of maternal diabetes, hypertension and cardiovascular disease were examined.
Results
Of 240 083 women, 213 765 (89%) had no GDM and were not overweight (reference group), 17 587 (7.3%) were overweight only, 7332 (3%) had GDM only and 1399 (0.6%) had GDM and were overweight. Significant differences in Caesarean section rates, induction rates and birthweight were observed across the four groups. During a median follow‐up of 5.3 years, diabetes incidence was 36% in the GDM and overweight, 18.8% in the GDM only, 4.8% in the overweight only and 1.1% in the reference group. With respect to hypertension and cardiovascular disease, the GDM and overweight group had the highest rates (26.8% and 3.1%, respectively) and the reference group had the lowest rates (5.8% and 1.0%, respectively). However, rates were similar in the GDM only (14.9% and 1.9%, respectively) and overweight only groups (14.9% and 1.5%, respectively).
Conclusions
Not surprisingly, the presence of both high maternal weight and GDM compounds the risk of developing diabetes. However, the association between overweight alone and GDM alone and hypertension and cardiovascular disease appears similar suggesting a need for effective interventions to manage both these conditions to improve the health of these patients.
What's new?
Our population‐based study of 240 083 women giving birth over a 10 year period examines how high maternal weight modulates the risk of gestational diabetes mellitus in the long‐term development of diabetes, hypertension and cardiovascular disease.
Our findings confirm the accepted paradigm that high maternal weight and gestational diabetes mellitus together significantly increase the risk of adverse pregnancy outcomes, as well as the future risk of chronic disease.
Interestingly, the association between high maternal weight alone and gestational diabetes mellitus alone and the development of hypertension and cardiovascular disease appears equivalent.