Gestational Diabetes and Postpartum Cardiovascular, Kidney, and Metabolic Disorders

Gestational diabetes is associated with future cardiometabolic risk, but postpartum evidence across the cardiovascular-kidney-metabolic (CKM) disorder spectrum remains limited.

To characterize the timing and magnitude of incident postpartum CKM disorders after a pregnancy complicated by gestational diabetes.

This retrospective cohort study used data from April 1, 2007, to October 12, 2023, from the Merative MarketScan commercial database. Participants were commercially insured females aged 12 to 55 years with a single delivery and no preexisting CKM disorders before delivery. Follow-up began after delivery and continued until incident diagnosis, disenrollment, or end of data availability. Data were analyzed from August 2025 to March 2026.

Gestational diabetes, identified using diagnosis codes requiring 1 or more inpatient claims or 2 or more outpatient claims during pregnancy.

Incident postpartum diagnoses of obesity, hypertension, hyperlipidemia, prediabetes, type 2 diabetes, metabolic syndrome, chronic kidney disease, and cardiovascular disease. Cox proportional hazards regression models estimated adjusted hazard ratios (AHRs) and 95% CIs. Temporal patterns were assessed using postpartum interval-specific HRs and year-specific incidence rate ratios.

Of 1 153 998 females (mean [SD] age, 28.0 [5.8] years), 95 103 (8.2%) had gestational diabetes; median follow-up was 2.4 years (IQR, 1.6-3.8 years). Compared with individuals without gestational diabetes, those with gestational diabetes had higher crude incidence rates per 1000 person-years of type 2 diabetes (9.9 vs 1.0), prediabetes (12.9 vs 2.5), hyperlipidemia (19.9 vs 10.1), hypertension (13.9 vs 8.1), and obesity (26.3 vs 15.2). In adjusted models, gestational diabetes was associated with dysglycemia, including type 2 diabetes (time-averaged AHR, 10.02; 95% CI, 9.53-10.52) and prediabetes (AHR, 5.32; 95% CI, 5.12-5.53), metabolic syndrome (AHR, 2.72, 95% CI, 2.49-2.98), hyperlipidemia (AHR, 2.00; 95% CI, 1.95-2.06), hypertension (AHR, 1.76; 95% CI, 1.70-1.82), and obesity (AHR, 1.75; 95% CI, 1.71-1.79). Composite cardiovascular disease risk was elevated (AHR, 1.28; 95% CI, 1.18-1.40), whereas chronic kidney disease was not (AHR, 0.96; 95% CI, 0.76-1.22).

In this cohort study, gestational diabetes was associated with increased postpartum risk across multiple metabolic disorders. These findings suggest that postpartum care after gestational diabetes may need to extend beyond glucose monitoring to include broader cardiometabolic risk surveillance.