Hypertensive disorders of pregnancy and gestational diabetes mellitus and predicted risk of maternal cardiovascular disease 10-14 years after delivery: A prospective cohort.

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2025-01-17 DOI:10.1111/dme.15516

Kartik K Venkatesh, William A Grobman, Jiqiang Wu, Nilay S Shah, Michael Pencina, Maged M Costantine, Mark B Landon, Patrick Catalano, William L Lowe, Denise M Scholtens, Sadiya S Khan

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Abstract

Aims: Studies evaluating the relationship between adverse pregnancy outcomes (APOs), namely hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with the estimated risk of atherosclerotic cardiovascular disease (ASCVD) remains limited and could inform patient-centred decision-making in the postpartum period. We examined whether HDP or GDM were associated with a higher 10- and 30-year predicted risk of ASCVD measured 10-14 years after delivery.

Methods: A secondary analysis from the international prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (2013-2016) cohort. The exposures were HDP or GDM (untreated according to the International Association of the Diabetes and Pregnancy Study Groups criteria). Outcomes were 10- and 30-year predicted risk of ASCVD (composite of fatal and non-fatal coronary heart disease and stroke) as quantified by the validated Framingham Risk Score as a continuous measure, and secondarily, at thresholds used for clinical decision-making of ≥7.5% for 10-year predicted risk and ≥20% for 30-year predicted risk.

Results: Of 4432 individuals at a median age of 30.5 years and a median gestational age of 27.9 weeks at pregnancy enrollment, 10.7% developed HDP and 13.7% developed GDM. At 10-14 years after delivery, individuals with HDP had a higher 10-year predicted risk of ASCVD (least squares mean: 2.9% vs. 2.2%; adj. β: 0.59; 95% CI: 0.41-0.77) and a higher 30-year predicted risk of ASCVD (7.7% vs. 6.1%; adj. β: 1.27; 95% CI: 0.81-1.72) compared with those without HDP. Similarly, individuals with GDM had a higher predicted risk of ASCVD (10-year: 3.2% vs. 2.1%; adj. β: 0.51; 95% CI: 0.34-0.67 and 30-year: 8.8% vs. 5.8%; adj. β: 1.56; 95% CI: 1.11-2.01) compared with those without GDM. These results were similar when predicted ASCVD risk was assessed at thresholds of ≥7.5% at 10 years and ≥20% at 30 years.

Conclusion: Individuals who experienced HDP or GDM had a higher predicted 10- and 30-year risk of ASCVD measured 10-14 years after delivery compared with individuals who did not experience these APOs.

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妊娠期高血压疾病和妊娠期糖尿病与分娩后10-14年母体心血管疾病的预测风险：一项前瞻性队列研究

目的：评估妊娠不良结局（APOs），即妊娠高血压疾病（HDP）和妊娠糖尿病（GDM）与动脉粥样硬化性心血管疾病（ASCVD）估计风险之间关系的研究仍然有限，可以为产后以患者为中心的决策提供信息。我们研究了HDP或GDM是否与分娩后10-14年ASCVD的10年和30年预测风险较高相关。方法：对国际前瞻性高血糖和不良妊娠结局随访研究（2013-2016）队列进行二次分析。暴露为HDP或GDM（根据国际糖尿病和妊娠研究小组协会的标准未经治疗）。结果是10年和30年ASCVD预测风险（致命和非致命冠心病和中风的组合），通过验证的Framingham风险评分作为连续测量来量化，其次，用于临床决策的阈值为10年预测风险≥7.5%，30年预测风险≥20%。结果：4432例患者中位年龄为30.5岁，中位胎龄为27.9周，10.7%发展为HDP， 13.7%发展为GDM。在分娩后10-14年，HDP患者患ASCVD的10年预测风险较高(最小二乘平均值：2.9% vs. 2.2%；β: 0.59；95% CI: 0.41-0.77)和更高的30年ASCVD预测风险(7.7% vs. 6.1%；j. β: 1.27；95% CI: 0.81-1.72)。同样，GDM患者ASCVD的预测风险更高(10年：3.2% vs. 2.1%；β: 0.51；95% CI: 0.34-0.67, 30岁：8.8% vs. 5.8%；Adj. β: 1.56；95% CI: 1.11-2.01)。当预测ASCVD风险的阈值为10年≥7.5%和30年≥20%时，这些结果相似。结论：与没有经历过这些apo的个体相比，经历过HDP或GDM的个体在分娩后10-14年预测的10年和30年ASCVD风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”