Patients with gestational diabetes at increased risk of total and CVD related mortality: JAMA

USA: Findings from a recent study published in JAMA Internal Medicine have found an elevated risk of total and cardiovascular disease mortality in participants with gestational diabetes. 

The researchers revealed that participants who reported a history of gestational diabetes showed a small but increased risk of subsequent mortality over 30 years. The findings stress the importance of considering gestational diabetes as a critical factor in later-life mortality risk.

Gestational diabetes, a condition occurring during pregnancy, has long been associated with various health concerns. The study by Yi-Xin Wang and colleagues, spanning three decades and involving over 90,000 parous participants, sheds light on its long-term impact. The study, conducted among female nurses aged 25 to 42 in the United States, explores the connections between gestational diabetes and both overall and cause-specific mortality.

The study included 91,426 parous participants, with a mean age of 34.9 years and an average body mass index (BMI) of 24.1 at the beginning of the study in 1989. The study followed these participants for a remarkable 30 years, accumulating a total of 2,609,753 person-years of data. Over the course of the study, 3,937 deaths were recorded. Among these, 255 were due to cardiovascular disease, and 1,397 were attributed to cancer.

● Participants with a history of gestational diabetes exhibited a higher crude mortality rate than those without this history, with 1.74 vs. 1.49 deaths per 1,000 person-years, respectively.

● The hazard ratio (HR) for total mortality among those with gestational diabetes was 1.28 (95% CI, 1.13-1.44).

● After adjusting for potential confounding factors and lifestyle choices during the reproductive years, this risk remained elevated, with an HR of 1.25 (95% CI, 1.11-1.41).

● The association persisted even when considering subsequent development of type 2 diabetes and was particularly pronounced in individuals who led less healthy lifestyles.

● Those who experienced gestational diabetes in two or more pregnancies, or in both initial and subsequent pregnancies, had notably higher HRs.

● Concurrent conditions during pregnancy, such as hypertensive disorders, preterm birth, or low birth weight, also intensified the association.

● Cause-specific mortality analysis indicated that gestational diabetes was directly linked to an increased risk of cardiovascular disease-related mortality (HR, 1.59; 95% CI, 1.03-2.47).

● Gestational diabetes was inversely associated with cancer mortality (HR, 0.76; 95% CI, 0.59-0.98), but this effect was primarily observed among participants who later developed type 2 diabetes.

This comprehensive cohort study spanning three decades underscores the long-term health implications of gestational diabetes. Participants with a history of gestational diabetes had a slightly elevated risk of mortality over the 30-year study period. This emphasises the importance of recognizing gestational diabetes as a critical factor in assessing later-life mortality risk. These findings could have significant implications for healthcare providers and pregnant individuals, highlighting the need for closer monitoring and long-term follow-up of individuals with a history of gestational diabetes. Preventive measures and lifestyle interventions may also be warranted to mitigate associated risks.

Reference:

Wang, Y.-X., Mitsunami, M., Manson, J. E., Gaskins, A. J., Rich-Edwards, J. W., Wang, L., Zhang, C., & Chavarro, J. E. (2023). Association of gestational diabetes with subsequent long-term risk of mortality. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2023.4401