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Am J Perinatol 2023; 40(06): 589-597
DOI: 10.1055/a-1970-7892
SMFM Fellowship Series Article

Long-Term Maternal Metabolic and Cardiovascular Phenotypes after a Pregnancy Complicated by Mild Gestational Diabetes Mellitus or Obesity

Ashley N. Battarbee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lisa Mele
2   George Washington University Biostatistics Center, Washington, District of Columbia
,
Mark B. Landon
3   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Michael W. Varner 
4   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Brian M. Casey
5   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Uma M. Reddy
6   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
7   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Dwight J. Rouse
8   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
John M. Thorp
9   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Edward K. Chien
10   Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
George Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Beth A. Plunkett
12   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Sean C. Blackwell
13   Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas
,
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network › Author Affiliations Funding This study was supported by grants from the U.S. Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD [grant numbers: HD27915, U10 HD36801, HD34208, HD34116, HD40485, HD40500, HD27869, HD40560, HD40544, HD53097, HD40512, and HD40545]) and the U.S. Department of Health and Human Services, National Institutes of Health's National Center for Advancing Translational Sciences (NCATS [grant numbers: UL1TR001070 and UL1TR000439]). Comments and views of the authors do not necessarily represent views of the National Institutes of Health. A.N.B. was supported by NICHD (grant no.: K23HD103875) during the study.
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Abstract

Objective The aim of this study was to evaluate the association of mild gestational diabetes mellitus (GDM) and obesity with metabolic and cardiovascular markers 5 to 10 years after pregnancy.

Study Design This was a secondary analysis of 5- to 10-year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/homeostatic model assessment of insulin resistance (HOMA-IR), and cardiovascular markers vascular endothelial growth factor, (VEGF), vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 40 ligand (CD40L), growth differentiation factor 15 (GDF-15), and suppression of tumorgenesis 2 (ST-2). Multivariable linear regression estimated the association of GDM and obesity with biomarkers.

Results Of 951 participants in the parent study, 642 (68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences, −0.24 and −0.15; 95% confidence intervals [CIs], −0.36 to −0.12 and −0.28 to −0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference, −0.11; 95% CI, −0.19 to −0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference, −0.42; 95% CI, −0.52 to −0.32), but not other biomarkers.

Conclusion Prior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction 5 to 10 years after delivery.

Key Points

  • Mild GDM increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.

  • Obesity increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.

  • Neither mild GDM nor obesity increased the risk of cardiovascular dysfunction 5 to 10 years postpartum.

Keywords

cardiovascular disease - diabetes - gestational diabetes - obesity - pregnancy

Presentation

This study was presented at the 40th Annual Meeting of the Society for Maternal-Fetal Medicine, Grapevine, TX, February 3–8, 2020.


Supplementary Material



Publication History

Received: 03 October 2022

Accepted: 24 October 2022

Accepted Manuscript online:
02 November 2022

Article published online:
24 January 2023

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