Key result
Cumulative occurrences of gestational diabetes or hypertension linked to up to ~193% higher CVD risk.
Why the study?
Gestational diabetes and hypertension signal elevated cardiovascular risk, but there is little study of how the occurrence and recurrence of these conditions relate to cardiovascular disease.
Does the number of occurrences of gestational diabetes and gestational hypertension across two pregnancies increase the risk of cardiovascular disease in women?
Cohort (n=431,980)
Does the number of occurrences of gestational diabetes and gestational hypertension across two pregnancies increase the risk of cardiovascular disease in women?
Hazard Ratio: 1.47 (95% CI 1.35–1.61)
A history of multiple occurrences of gestational diabetes and/or gestational hypertension across pregnancies exhibits a dose-response relationship with long-term cardiovascular disease risk.
May warrant closer long-term CVD monitoring after recurrent gestational complications; leaves open causal mechanisms and intervention effects.
AIMS: Gestational diabetes (GDM) and hypertension (GHTN) occurrences signal elevated cardiovascular disease (CVD) risk. There is little study of occurrence and recurrence of these conditions in relationship to CVD. Among women with two singleton pregnancies, we aimed to quantify CVD risk in relationship to the number of GDM/GHTN occurrences. METHODS: In this Quebec-based retrospective cohort study (n = 431,980), we ascertained the number of GDM/GHTN occurrences over two pregnancies and assessed for CVD over a median of 16.4 years (cohort inception 1990-2012, outcomes 1990-2019). We defined CVD as a composite of myocardial infarction, stroke, and angina, requiring hospitalization and/or causing death. We adjusted Cox proportional hazards models for offspring size, preterm/term birth status, maternal age group, time between deliveries, ethnicity, deprivation level, and co-morbid conditions. RESULTS: Compared to absence of GDM/GHTN in either pregnancy, one GDM/GHTN occurrence increased CVD hazards by 47% (hazard ratio [HR] = 1.47, 95% confidence interval [CI] 1.35-1.61), two occurrences nearly doubled hazards (HR = 1.91, 95% CI 1.68-2.17), and three or more approximately tripled CVD hazards (HR = 2.93, 95% CI 2.20-3.90). Individual components of the composite demonstrated similar findings. CONCLUSIONS: Health care providers and mothers should consider a complete history of GDM/GHTN occurrences to ascertain the importance and urgency of preventive action.
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Mussa et al. (2023) conducted a cohort in Gestational diabetes and gestational hypertension (n=431,980). Gestational diabetes or gestational hypertension occurrence vs. Absence of GDM/GHTN in either pregnancy was evaluated on Composite of myocardial infarction, stroke, and angina, requiring hospitalization and/or causing death (HR 1.47, 95% CI 1.35-1.61). Having one, two, or ≥3 occurrences of gestational diabetes or hypertension across two pregnancies progressively increased cardiovascular disease risk compared to no occurrences (HR 1.47, 1.91, and 2.93).
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