Gestational Diabetes Raises Heart Attack, Stroke Risk, NIH Study Finds

If a mother develops gestational diabetes while pregnant, she has a higher risk of developing cardiovascular disease (CVD) later in life. However, a recent study also showed that CVD after gestational diabetes can be prevented by adopting a healthy lifestyle and avoiding weight gain after the baby arrives.

In fact, authors of an accompanying editorial suggest that the demands of pregnancy on the body serve as an early stress test, and gestational diabetes is perhaps a warning signal for women to act.

The findings, published in JAMA Internal Medicine¹, draw from the Nurses’ Health Study II, and include data from 90,000 women who were followed starting before pregnancy and to their early senior years.

Gestational diabetes occurs when blood glucose becomes elevated during pregnancy. The condition typically disappears after giving birth, but women who have had the condition are known to be at higher risk for type 2 diabetes (T2D) as they age. In this study, the mean age of the participants was 34.9 years. After adjusting for age, body mass index (BMI) before pregnancy, and other factors, the study found that women who failed to adopt a healthy lifestyle after a diagnosis of gestational diabetes in pregnancy were 43% more likely to develop CVD.

After adjusting for weight gain and lifestyle factors after pregnancy, the relative risk of developing CVD was found to be 29% higher. Notably, the risk for CVD remains 30% higher even in those women who did not develop type 2 diabetes.

In their editorial, authors Erica P. Gunderson, PhD, MPH, MS, and Mark Jaffe, MD,² write that these findings amplify other research that shows that gestational diabetes presents its own risk for future CVD “even without impaired glucose tolerance or dyslipidemia before or after pregnancy.”

This findings from the Nurses’ Health Study confirmed other findings that women who develop gestational diabetes are at risk for high blood pressure, stroke, heart attack, or hardening of the arteries.

Gunderson and Jaffe said the actual connection between gestational diabetes and CVD may be stronger due to design factors of the Nurses’ Health Study that may have excluded some women with gestational diabetes. Other data sets suggest so, including those from the Diabetes Prevention Program, which find a 71% higher relative risk of diabetes among women with gestational diabetes.

A statement from the National Institutes of Health said the study “provides some of the strongest evidence to date that cardiovascular disease after gestational diabetes isn’t inevitable for women who adopt a healthy diet, maintain a healthy weight, exercise moderately, and do not smoke.”

References

1. Tobias, DK, Stuart JJ, Li S, et al. Association of history of gestational diabetes with long-term cardiovascular disease risk in a Large Prospective Cohort of US Women [published online October 16, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.2790.

2. Gundererson EP, Jaffe MG. Pregnancy and subsequent glucose intolerance in women of child-bearing age [published online October 16, 2017]. JAMA Intern Med.