ArticleBMC medicine2022
Mediating effect of vascular risk factors underlying the link between gestational diabetes and cardiovascular disease.
Article in BMC medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Prevalence of gestational diabetes in the United States and Canada: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2024Pooled it
- Associations of gestational diabetes mellitus with the risk of cardiometabolic diseases: results from NHANES and mendelian randomization analyses.Diabetology & metabolic syndrome · 2025Article
- The Predictive Effects of Atherogenic Indices and Remnant Cholesterol on Gestational Diabetes Mellitus Risk.Diabetes, metabolic syndrome and obesity : targets and therapy · 2025Article
- Association between gestational diabetes and cardiovascular disease within 24 months postpartum.American journal of obstetrics & gynecology MFM · 2024Article
- Pregnancy, Reproductive Factors, and Female Heart Failure Risk and Outcomes.Current heart failure reports · 2024Review
- Health impacts of new-onset diabetes in women post-gestational diabetes mellitus: Insights from Hong Kong's territory-wide data.Journal of diabetes investigation · 2024Article
- Implementing care for women with gestational diabetes after delivery-the challenges ahead.Frontiers in global women's health · 2024Review
- Correlation between gestational diabetes mellitus and postpartum cardiovascular metabolic indicators and inflammatory factors: a cohort study of Chinese population.Frontiers in endocrinology · 2024Article
- Is There a Relationship between Adverse Pregnancy Outcomes and Future Development of Atherosclerosis?Biomedicines · 2023Review
- Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health.Circulation research · 2023Review
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWomen with gestational diabetes (GDM) have an elevated lifetime incidence of cardiovascular disease (CVD), but the basis of this excess risk remains to be established. In this context, we hypothesized that chronic exposure to adverse cardiovascular risk factors may contribute to their elevated risk of CVD. We thus sought to quantify the determinants of CVD risk in women with a history of GDM by performing mediation analyses.
methodsWomen in Ontario, Canada, with a live-birth pregnancy between Jan 1998 and Dec 2017 (n=757,541) were followed for a median of 13.2 years and stratified into the following 4 groups: women with GDM who developed CVD (GDM+/CVD+); women without GDM who developed CVD (GDM-/CVD+); those with GDM but no CVD (GDM+/CVD-); and those with neither GDM nor CVD (GDM-/CVD-). Lipids (total cholesterol, LDL, HDL, triglycerides) and glycemic variables (A1c, fasting glucose) were measured between 4.3±3.0 and 4.8±3.4 times over follow-up.
resultsOn successive measurements at a median of 4.8, 7.1, and 8.7 years postpartum, respectively, each lipid and glycemic measure progressively worsened from GDM-/CVD- to GDM+/CVD- to GDM-/CVD+ to GDM+/CVD+ (all p<0.0001). At each point in time, each of the lipid and glycemic measures was significantly worse in GDM+/CVD+ compared to GDM+/CVD- (all p<0.001). Moreover, among women who did not develop CVD, all lipid and glycemic measures were significantly worse in those with previous GDM (all p<0.001 for GDM+/CVD- vs GDM-/CVD-). Mediation analyses revealed that the dominant determinants of CVD risk in women with GDM were A1c (56.0% mediation, 95%CI 47.4-67.8) and fasting glucose (47.4%, 38.8-60.8), followed by HDL (25.2%, 21.3-30.7) and triglycerides (12.1%, 9.7-15.6). Upon exclusion of those who developed diabetes during follow-up, the key determinants were HDL (40.8%), fasting glucose (37.7%), A1c (28.6%), triglycerides (21.0%), and LDL (9.9%).
conclusionsAdverse glycemic and lipid measures mediate the elevated risk of CVD in women with previous GDM, with the impact of lipids particularly evident in those who do not develop diabetes. These findings thus identify potential targets for risk factor monitoring and ultimately early intervention towards the goal of primary prevention of CVD in this at-risk patient population.
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