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

Published:March 26, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.03.007

      Abstract

      Objectives

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Résumé

      Objectifs

      Il est connu que le diabète gestationnel est associé à un risque accru de maladies cardiovasculaires ultérieures chez la mère. Toutefois, on ne connaît pas les paramètres glycémiques gestationnels qui entraînent ce risque. L'objectif de l’étude était d’évaluer la relation entre les paramètres glycémiques gestationnels et le diabète gestationnel, et le risque cardiométabolique futur.

      Méthodes

      L’étude de cohorte regroupait des sujets qui avaient subi une épreuve d'hyperglycémie provoquée par voie orale après l'ingestion de 75 grammes de glucose au Mater Dei Hospital, à Malte, en 2009, pour évaluer le diabète gestationnel. Ces patients ont par conséquent eu un suivi jusqu'en janvier 2018. L’épaisseur de l'intima-média carotidienne a servi de marqueur d'athérosclérose subclinique des deux artères carotides communes.

      Résultats

      L'âge moyen de la population étudiée était de 38,3 ± 5,4 ans. Parmi les 203 participantes, 43 (21,2 %) avaient un diabète gestationnel. Dans les analyses univariées et multivariées après un suivi médian de 8 ans, le diabète gestationnel et les paramètres glycémiques individuels de l’épreuve d'hyperglycémie provoquée par voie orale durant la grossesse ont été associés à des concentrations plus élevées d'hémoglobine glyquée, des concentrations plasmatiques de la glycémie à jeun plus élevées, des concentrations de cholestérol de faible densité plus élevées et à des concentrations de cholestérol de haute densité plus faibles ainsi qu’à la présence du syndrome métabolique. Ni le diabète gestationnel ni les paramètres glycémiques individuels des épreuves d'hyperglycémie provoquée par voie orale durant la grossesse n'ont été associés à l’épaisseur présente de l'intima-média carotidienne.

      Conclusions

      Nos résultats montrent que les seuils de paramètres glycémiques ne permettent pas de prédire le risque cardiométabolique futur. Nos données suggèrent également que l'association connue entre le diabète gestationnel et les maladies cardiovasculaires est médiée, du moins en partie, par une glycémie plus élevée après la grossesse et de plus mauvais profils lipidiques, même si ces paramètres métaboliques demeurent souvent dans les valeurs normales.

      Keywords

      Mots Clés

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