Increased cardiovascular risk found in women with glucose concentrations at the upper limit of the normal range during pregnancy.
Glucose screening during pregnancy may predict future cardiovascular (CV) risk in women with and without Gestational diabetes, according to the results of the study published in The Lancet Diabetes & Endocrinology. CV risk was found to be higher with abnormal glucose screening tests, but there was also increased CV risk in women with glucose concentrations at the upper limit of the normal range.
In studies to date, gestational diabetes has consistently been associated with an increased future risk of cardiovascular disease, regardless of the protocol for antepartum screening or the diagnostic criteria for which gestational diabetes is diagnosed. Previous studies have shown that gestational diabetes is a risk factor for CV morbidity. The researchers hypothesized that screening for glucose during pregnancy may predict CV disease in women who do not have gestational diabetes. The objective of the study was to investigate the association between the results of the glucose challenge test during pregnancy and the future CV risk in the general obstetric population and women without gestational diabetes.
The researchers argued that the resulting heterogeneity in the severity of dysglycemia in women with gestational diabetes suggests that the relationship between gestational glycemia and subsequent cardiovascular disease probably extends to the non-diagnostic interval. Thus, they hypothesized that screening for glucose in pregnancy would identify the future risk of cardiovascular disease in women who did not have gestational diabetes.
The population-based retrospective cohort study used administrative databases from the Ministry of Health and Long-Term Care of Ontario, Canada. The study involved all women in the Ontario database who took an oral 50 g glucose test during gestation between 24 and 28 weeks gestation and who had a birth between July 2007 and December 2015.
Gestational diabetes was defined as a 1-hour plasma glucose post-challenge ≥200 mg / dl (11.1 mmol / L) or a result between 140 mg / dL and 195 mg / dL (7.8 and 11.0 mmol / L) ) with a diagnostic record of diabetes in the hospital delivery record. The participants were divided into 6 equal groups based on the results of the glucose screening test for: ≤86mg / dL to 89mg / dL (4.8 – 4.9 mmol / L) at 100mg / dL. (5.5 mmol / L) 100-115mg / dl (5.6 to 6.2 mmol / l); 115-125 mg / dL (6.3 to 6.9 mmol / L) 126-143 mg / dL (7.0 to 7.9 mmol / L); and ≥145mg / dL (8.0 mmol / L)
The primary endpoint was cardiovascular disease (a compound of hospitalization for myocardial infarction, acute coronary syndrome, stroke, myocardial revascularization, percutaneous coronary intervention, or carotid endarterectomy). All women were followed from pregnancy rate to the event of cardiovascular disease, death, or migration on September 30, 2017, whichever comes first.
259,164 women were identified as eligible for this study: 13,609 who had gestational diabetes and 245,555 women without gestational diabetes. Women were followed for a median of 3.9 years (IQR 2 · 8-5 · 6) for the development of cardiovascular disease. Each increase of 1 mmol / L in the result of the glucose stimulus test was associated with a 13% higher risk of cardiovascular disease (after adjusting for age, ethnicity, income and rurality, adjusted risk ratio). [HR] 1 · 13, 95% CI 1 · 04-1 · 22). This relationship persisted after the exclusion of women with gestational diabetes (1 · 14, 1 · 01-1 · 28). In women without gestational diabetes, those with an abnormal glycemic challenge test (140mg / dL.) (≥7.8 mmol / L) and those with a result of 130mg / dL. and 140 mg / dL (7 · 2 and 7 · 7 mmol / L) had an increased risk of cardiovascular disease (HR 1 · 94, 95% CI 1 · 29-2 · 92 and 1 · 65,0 · 99 -2 · 76, respectively) compared to those with a score of 128mg / dL (7 · 1 mmol / L) or less (p = 0.003).
In the group of women without gestational diabetes, CV risk was higher in patients with an abnormal glucose screening test 140 mg / dL. (≥7.8 mmol / L), but there was also an increase in CV risk in patients with a glucose concentration at the upper limit of the normal range
"The screening of pregnant glucose in current obstetrical practices offers the ability to identify future risks [for CV disease] in both those with gestational diabetes and those who are clinically classified as not having gestational diabetes, "the researchers concluded.
- Screening for glucose during pregnancy may help identify future cardiovascular risk among women with and without gestational diabetes.
- Each increase of 1 mmol / L in the result of the glucose stimulus test was associated with a 13% higher risk of cardiovascular disease
- The relationship between gestational glycemia and subsequent risk of cardiovascular disease extends to the normoglycemic range.
Retnakaran R, Shah BR. Glucose screening in pregnancy and future risk of cardiovascular disease in women: a population-based retrospective cohort study [published online March 27, 2019]. Lancet Diabetes Endocrinol. doi: 10.1016 / S2213-8587 (19) 30077-4