Risks include future cardiovascular and cerebrovascular diseases; managing other risk factors might prevent future overt diabetes.

Gestational diabetes mellitus (GDM) usually resolves after childbirth, but GDM confers excess risk for future type 2 diabetes, metabolic syndrome, chronic kidney disease and perhaps cardiovascular and cerebrovascular diseases.

In a meta-analysis of 15 observational studies with follow up ranging from one to 26 years, women who had GDM, compared with women who did not have GDM, were significantly more likely to develop cardiovascular diseases (risk ratio [RR], 1.7) and cerebrovascular diseases (RR, 1.4). The excess overall risk for cardiovascular and cerebrovascular disease was statistically significant even among women who did not develop type 2 diabetes (RR, 1.1); excess risk was attenuated (but not eliminated) in studies that were adjusted for smoking, body mass index and comorbidities.

Can women with prior GDM lower their risk for subsequent type 2 diabetes? In a prospective cohort study, 4300 women with prior GDM periodically reported weight and modifiable lifestyle factors (i.e. diet, exercise, alcohol consumption, and smoking) for a median 28 years. Risk for subsequent type 2 diabetes varied inversely with the number of optimised lifestyle factors (hazard ratios ranged from 0.94 for one optimised lifestyle factor to 0.08 for all five). The inverse association remained significant even for women who were overweight or obese and for those with genetic susceptibility to type 2 diabetes.

Comment: Prompt diagnosis and treatment of GDM are essential for preventing maternal and neonatal morbidity. But potential sequelae of GDM are also important, and managing modifiable risk factors after GDM might help lower the incidence of subsequent overt diabetes and its associated complications.
BRUCE SOLOWAY, MD
Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Xie W, et al. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ 2022; 378: e070244.
Yang J, et al. Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study. BMJ 2022; 378: e070312.

This summary is taken from the following Journal Watch title: Women’s Health.