Conjoint association of gestational diabetes mellitus and hypertensive disorders of pregnancy with long-term risk of mortality: a population-based cohort study

Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs) are common maternal complications. We sought to evaluate the independent and joint association of GDM and HDPs with all-cause, premature, and cause-specific mortality. Methods: We used data from the UK Biobank, which included 220 953 women who reported at least one live birth. Individual and joint associations of GDM and HDPs with all-cause, premature, and cause-specific mortality were estimated using Cox regression models. Results: During a follow-up of 12.9 years, women who experienced GDM had a higher risk of all-cause (hazard ratio (HR) = 1.57; 95% confidence interval (CI) = 1.26-1.96), premature (HR = 1.60; 95% CI = 1.24-2.06) and cardiovascular disease (CVD) mortality (HR = 2.60; 95% CI = 1.70-3.96). Women with a history of HDPs had an increased risk for CVD mortality (HR = 2.07; 95% CI = 1.51-2.83), but the association with all-cause death and premature death was not significant. Individuals who encountered both GDM and HDPs had a 3.9-fold higher relative risk of all-cause mortality (HR = 3.93; 95% CI = 1.88-8.24]) and a 4.3-fold higher risk of premature mortality (HR = 4.31; 95% CI = 1.94-9.57), compared to those without GDM or HDPs. Conclusions: Women with GDM have a higher risk of all-cause, premature mortality and both risks were higher than the impacts of a history of HDPs based on a large-scale population. The co-occurrence of GDM and HDPs will deteriorate the aforementioned situation compared to a single cardiometabolic pregnancy complication.