What is the clinical evidence from this study?

Study design: Cohort. Population: Previous gestational diabetes mellitus (n=700648). Intervention: Gestational diabetes mellitus (GDM) vs. No GDM. Primary outcome: Any cardiovascular and metabolic morbidity (adjusted HR 2.13, 95% CI 2.07-2.20).

September 9, 2022Cardiovascular DiabetologyOpen Access

Cardiovascular and metabolic morbidity in women with previous gestational diabetes mellitus: a nationwide register-based cohort study

View Full Paper

Ask AI

Bookmark

Key result

Previous gestational diabetes mellitus was associated with a more than twofold increased risk of any cardiovascular and metabolic morbidity (adjusted HR 2.13) compared to women without previous GDM.

Why the study?

Gestational diabetes mellitus has maternal health implications beyond the perinatal period, but the incidence and severity of subsequent cardiovascular and metabolic morbidity, and the influence of beta cell impairment proxies, required investigation.

Does gestational diabetes mellitus increase the risk of cardiovascular and metabolic morbidity in women?

Population

700,648 women delivering in Denmark during 1997-2018

Comparison

Gestational diabetes mellitus vs no gestational diabetes mellitus

Design

Nationwide register-based cohort study

Follow-up

Median 10.2-11.9 years

Authors

MCMaria Hornstrup ChristensenUniversity of Copenhagen KRKatrine Hass RubinUniversity of Southern Denmark TPTanja Gram PetersenUniversity of Southern Denmark

Discussion

Member takes

Implication

Supports enhanced postpartum CV monitoring after GDM; extends prior associations but leaves causal effects and interventions open.

Study Design

Type

Cohort (n=700,648)

Structured PICO

Does gestational diabetes mellitus increase the risk of cardiovascular and metabolic morbidity in women?

Population

700,648 women who delivered in Denmark between 1997 and 2018, free of preexisting diabetes and cardiovascular disease, followed for a median of 10.2 to 11.9 years.

Exposure

Gestational diabetes mellitus (GDM) during pregnancy

Comparator

No gestational diabetes mellitus during pregnancy

Outcome

Overall cardiovascular and metabolic morbidity (composite of ischemic heart disease, heart failure, stroke/transient cerebral ischemia, hypertension, venous thrombosis, dyslipidemia, cardiac arrhythmia, and/or related medication)composite

Main Result

Hazard Ratio: 2.13 (95% CI 2.07–2.2)

Absolute Event Rate: 27.59% vs 12.88%

Previous gestational diabetes mellitus is associated with a significantly higher long-term risk of cardiovascular and metabolic morbidity, highlighting the need for postpartum cardiovascular risk monitoring.

Limitations

Exclusion criteria for preexisting diabetes and CVD only applied to 2 years prior to index date
Potential changes in screening procedures, diagnostic criteria, and management over the long study period
GDM exposure likely underestimated due to selective screening in Denmark
Number of women treated with insulin during GDM was likely underestimated
Residual confounding despite confounder control
Some eligible confounders, including smoking, were self-reported and potentially underreported
Use of data on confounders and intermediate covariates from the index pregnancy, which may not be representative later in life
Subsequent diabetes was not differentiated into subtypes
Pragmatic choice of number of hospital contacts and redemptions as proxy for morbidity severity might not capture severity sufficiently
Potential surveillance bias due to recommended follow-ups for women with GDM
Likely underestimation of the proportion of women with insulin treatment
Missing data on pregestational BMI and smoking during pregnancy (handled in sensitivity analyses)

Cite This Study

Christensen et al. (2022) conducted a cohort in Previous gestational diabetes mellitus (n=700,648). Gestational diabetes mellitus (GDM) vs. No GDM was evaluated on Any cardiovascular and metabolic morbidity (adjusted HR 2.13, 95% CI 2.07-2.20). Previous gestational diabetes mellitus was associated with a more than twofold increased risk of any cardiovascular and metabolic morbidity (adjusted HR 2.13) compared to women without previous GDM.

synapsesocial.com/papers/6a99e3252a60c81fa4ac06f9 https://doi.org/10.1186/s12933-022-01609-2

Topics

Hypertension management Women and heart disease

View Full Paper

Ask AI

Bookmark

Cardiovascular and metabolic morbidity in women with previous gestational diabetes mellitus: a nationwide register-based cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Cardiovascular and metabolic morbidity in women with previous gestational diabetes mellitus: a nationwide register-based cohort study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider