23-Fold Increase in Heart Attack Risk among Women with Gestational Diabetes and Hypertension, reveals research

The findings were striking: women with a history of both GDM and GH were found to have a staggering 23-fold increased risk of experiencing a myocardial infarction within the first 5 years of their postnatal lives.

Cardiovascular disease ranks as the leading cause of death among women globally. While the connection between a history of hypertensive disorders during pregnancy or gestational diabetes (GDM) and subsequent cardiovascular events is well documented, the implications of experiencing both gestational hypertension (GH) and GDM together are less clearly understood. To address this gap, Laurent Fauchier, Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France, and colleagues examined the relationship between GDM and GH, evaluating their individual and combined effects on future cardiovascular risks. 

For this purpose, the researchers identified all female patients discharged from French hospitals in 2013 who had complete follow-ups for five years. These patients were categorized based on their history of gestational diabetes, gestational hypertension, both conditions, or neither. After applying propensity score matching, those with GDM and/or GH were matched 1:1 with patients who had no history of these conditions. The analysis adjusted hazard ratios (HR) for cardiovascular events during the follow-up period, accounting for the patient's age at baseline.

The study led to the following findings:

• Women with a history of gestational hypertension exhibited a significantly increased risk of cardiovascular death, with a hazard ratio (HR) of 5.46.
• Women with a history of gestational diabetes mellitus did not show a significant difference in the risk of cardiovascular events:
  • Myocardial infarction risk (HR 0.88) was not significantly elevated.
  • Cardiovascular death risk (HR 1.25) was also not significantly different.
• Women with a history of both GDM and GH faced a markedly higher risk of myocardial infarction, with a hazard ratio of 23.33.

In the largest contemporary analysis of hospitalized female patients to date, we present the first findings on the combined cardiovascular risk associated with gestational diabetes mellitus and gestational hypertension within five years postpartum.

"Our results indicate that women with a history of both conditions face a staggering 23-fold increased risk of myocardial infarction. Therefore, those who experience both GDM and GH during pregnancy should be referred for specialized ongoing cardiology care and classified as high risk when presenting with acute symptoms indicative of potential cardiac ischemia," the researchers concluded. 

Reference:

Bullough, S., Lip, G. Y., Fauchier, G., Herbert, J., Sharp, A., Bisson, A., Ducluzeau, P. H., & Fauchier, L. (2024). The impact of gestational diabetes and gestational hypertension on future cardiovascular events: A nationwide cross-sectional cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 301, 216-221. https://doi.org/10.1016/j.ejogrb.2024.08.021