Kidney Disease in Women With Previous Gestational Diabetes Mellitus: A Nationwide Register-Based Cohort Study

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Care Pub Date : 2023-12-15 DOI:10.2337/dc23-1092
Maria Hornstrup Christensen, Claus Bistrup, Katrine Hass Rubin, Ellen Aagaard Nohr, Christina Anne Vinter, Marianne Skovsager Andersen, Sören Möller, Dorte Moeller Jensen
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Abstract

OBJECTIVE The association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease were investigated in this study. RESEARCH DESIGN AND METHODS This Danish, nationwide, register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease, based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM in pregnancy and was included in the models as an interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses. RESULTS Data from 697,622 women were used. Median follow-up was 11.9 years. GDM was associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92; 95% CI 1.67–2.21), whereas acute kidney disease was unrelated to GDM. The proportions of indirect effects of diabetes and hypertension on the association between GDM and CKD were 75.7% (95% CI 61.8–89.6) and 30.3% (95% CI 25.2–35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared with women without GDM (aHR 2.35; 95% CI 1.39–3.97). CONCLUSIONS The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk.
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曾患妊娠糖尿病妇女的肾脏疾病:基于全国登记的队列研究
目的探讨妊娠期糖尿病(GDM)与肾脏疾病发生的关系、糖尿病和高血压的中介作用以及妊娠期代谢功能障碍严重程度对肾脏疾病发生风险的影响。研究设计和方法这项丹麦全国性的基于登记的队列研究包括了1997年至2018年间分娩的所有女性。结果包括慢性肾脏疾病(CKD)和急性肾脏疾病,基于诊断代码。Cox回归分析探讨了GDM与肾脏疾病之间的关系。妊娠期代谢功能障碍严重程度的代理是基于妊娠期GDM诊断和胰岛素治疗,并作为相互作用项纳入模型。随后的糖尿病和高血压在肾脏疾病之前的中介作用被量化使用中介分析。结果:研究数据来自697,622名女性。中位随访时间为11.9年。GDM与较高的CKD风险相关(校正风险比[aHR] 1.92;95% CI 1.67-2.21),而急性肾病与GDM无关。通过中介分析评估,糖尿病和高血压对GDM和CKD之间关联的间接影响比例分别为75.7% (95% CI 61.8-89.6)和30.3% (95% CI 25.2-35.4)。与没有GDM的女性相比,接受胰岛素治疗的GDM且无后续糖尿病的女性CKD风险显著增加(aHR 2.35;95% ci 1.39-3.97)。结论:无论随后是否发展为糖尿病和高血压,GDM后CKD的风险均显著升高。此外,怀孕期间有严重代谢功能障碍的妇女患CKD的风险最高。
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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