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Gestational diabetes may put women at risk for various cardiovascular illnesses later in life, researchers found.

Women with a history of gestational diabetes had an increased risk for total cardiovascular outcomes compared with those who did not (7.80 vs 5.81 new incidences per 1,000 person-years, respectively; HR 1.37, 95% CI 1.19-1.57, P<0.001), reported Seung Mi Lee, MD, PhD, of the Seoul National University College of Medicine, during the Society for Maternal-Fetal Medicine virtual meeting.

"Women with a gestational diabetes history are at an increased risk of long-term cardiovascular complications, even in the elderly population," Lee said. Chronic metabolic comorbidities may partly explain the association between gestational diabetes and later cardiovascular illness, she added.

Specifically, those with a history of gestational diabetes had higher risks of:

• Coronary artery disease (HR 1.330, P=0.003)
• Myocardial infarction (HR 1.678, P<0.001)
• Ischemic stroke (HR 1.696, P=0.004)
• Peripheral artery disease (HR 1.064, P=0.007)
• Heart failure (HR 1.426, P=0.013)
• Mitral regurgitation (HR 2.276, P<0.001)
• Atrial fibrillation/flutter (HR 1.474, P<0.001)

In mediation analyses, Lee's group found that subsequent overt diabetes explained 23% of the association between gestational diabetes and overall cardiovascular outcomes. Hypertension explained 11% of this association, and dyslipidemia explained 10%.

Lee and colleagues used data from the U.K. Biobank, a prospective cohort of more than 500,000 people ages 40 to 60, who were enrolled from 2006 to 2010 with ongoing follow-up. All women included in the study reported at least one live birth.

Overall, there were 219,330 women included in the study, 1,390 of whom had gestational diabetes during pregnancy. Cases of gestational diabetes were identified by participants' self-reported data at enrollment or ICD codes. Median follow-up was 10 years. Approximately 6% of women developed new cardiovascular outcomes during follow-up.

Women with a history of gestational diabetes were more likely to be younger at enrollment; have a higher BMI; have higher rates of overt diabetes, hypertension, and dyslipidemia at baseline; and lower rates of hysterectomy, use of hormone replacement therapy, and smoking.

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