November 2023
Gestational diabetes and early mortality

During 30 years of follow up, women with prior gestational diabetes had 30% higher risk for death than those without such history.

Gestational diabetes (GD) is associated with development of type 2 diabetes and other adverse outcomes. In this study, researchers used data from the prospective Nurses’ Health Study to assess the association between GD and risk for early death among 91,000 female nurses (baseline mean age, 35 years) who had at least one pregnancy at age 18 years or older. About 6000 participants (7%) reported having GD.

After adjustment for multiple potential confounders, risk for all-cause death during 30 years of follow up was significantly higher among participants with GD than among participants without GD (hazard ratio [HR], 1.3). This association persisted regardless of whether type 2 diabetes developed subsequently and was more robust among those who had GD in two or more pregnancies, had concurrent hypertension or delivered preterm infants. Participants with GD had higher risk for cardiovascular (CV)-related death (HR, 1.6) and for non-CV-related, noncancer-related death (HR, 1.5) but lower risk for cancer-related death (HR, 0.8). 

Comment: The authors speculate that pregnant women who develop GD might be predisposed to chronic disease through shared pathways that predate pregnancy (e.g. systemic inflammation, insulin resistance, endothelial dysfunction). Reasons for the inverse association between GD and cancer-related death are unclear.

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Wang Y-X, et al. Association of gestational diabetes with subsequent long-term risk of mortality. JAMA Intern Med 2023 Sep 11; e234401.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Women’s Health.

JAMA Intern Med