Gestational Glycemic Parameters and Future Cardiometabolic Risk at Medium-Term Follow Up

Gestational diabetes is known to be associated with increased risk for future maternal cardiovascular disease. However, it is not known which gestational glycemic parameters mediate this risk. The study's aim was to assess the relationship between gestational glycemic parameters and gestational diabetes with future cardiometabolic status.

This cohort study comprised subjects who underwent assessment for gestational diabetes by means of a 75 g oral glucose tolerance test at Mater Dei Hospital, Malta, during 2009. These patients were consequently followed up through January 2018. Carotid intima-media thickness was assessed as a marker of subclinical atherosclerosis in both common carotid arteries.

The mean age of the study population was 38.3±5.4 years. Of the 203 participants, 43 (21.2%) had gestational diabetes. Gestational diabetes and individual glycemic parameters of intrapregnancy oral glucose tolerance tests were associated with higher glycated hemoglobin, fasting plasma glucose, low-density-cholesterol and lower high-density-cholesterol levels and with the presence of the metabolic syndrome in both univariate and multivariate analyses after a median follow up of 8 years. Neither gestational diabetes nor individual glycemic parameters of intrapregnancy oral glucose tolerance tests was associated with current carotid intima-media thickness.

Our results suggest that there is no threshold of glycemic parameters for predicting future cardiometabolic status. Our data also suggest that the known association between gestational diabetes and cardiovascular disease is mediated, at least in part, by higher postpregnancy glycemia and worse lipid profiles, even though these metabolic parameters often remain within the normal range.