Gestational Diabetes and Incident Hospitalization for Cardiovascular Disease: A Nationwide French Cohort Study.

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of mortality in women. We investigated the associations between gestational diabetes (GD) and the incidence of various CVD outcomes.

Methods: This nationwide population-based cohort study included 1 436 468 parous women in France during 2012 to 2013. We used Cox regression to (1) quantify the association of GD with incident hospitalization for chronic hypertension as well as overall and type-specific CVD, (2) investigate the timing to GD-related CVD onset in the postpartum period, and (3) assess the impact of the recurrence of GD on CVD incidence.

Results: Women with a history of GD (n=101 814) had a 97% increased relative risk of chronic hypertension (hazard ratio [HR], 1.97 [95% CI, 1.89-2.06]) and a 31% higher overall CVD risk (HR, 1.31 [95% CI, 1.22-1.41]) compared with those without such history. There were increased risks of specific CVDs associated with GD (versus no GD), including increased coronary heart disease (HR, 1.71 [95% CI, 1. 50-1.94]), heart failure (HR, 1.41 [95% CI, 1.21-1.65]), and stroke (HR, 1.16 [95% CI, 1.06-1.28]) risks. The elevated risk was apparent as early as 1 year postpartum for chronic hypertension and CVD outcomes, and the elevated CVD risk was more pronounced among women with ≥2 pregnancies complicated by GD during the study period than in those with 1 GD episode.

Conclusions: GD was associated with increased risks of overall and specific CVD, as well as the risk of incident chronic hypertension. The elevated CVD risk was present early in postpartum and persisted over time, and was higher with repeated GD.