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Increased cardiovascular risk in women whose glucose levels are in the upper part of the normal range during pregnancy.
Glucose screening during pregnancy can predict future cardiovascular (CV) risk in women with and without Gestational Diabetes, according to the results of the study published in The Diabetes Lancet & Endocrinology. Abnormal glucose testing revealed a higher CV risk, but CV risk also increased in women with higher glucose levels than normal.
In studies to date, gestational diabetes has always been badociated with an increased future risk of cardiovascular disease, regardless of the antepartum screening protocol or diagnostic criteria against which gestational diabetes is diagnosed. Previous studies have shown that gestational diabetes is a risk factor for CV morbidity. The researchers in the study hypothesized that glucose screening during pregnancy can predict cardiovascular disease in women who do not have gestational diabetes. The purpose of their study was to investigate the badociation between the results of blood glucose tests during pregnancy and the future risk of CV in the general obstetric population and in women without gestational diabetes.
The investigators felt that the heterogeneity of dysglycemia in women with gestational diabetes suggests that the relationship between gestational glucose and subsequent cardiovascular disease probably extends to areas other than the diagnosis. They hypothesized that screening for glucose during pregnancy would identify the future risk of cardiovascular disease in women who did not have gestational diabetes.
The population-based retrospective cohort study used administrative databases from the Ministry of Health and Long-Term Care of Ontario, Canada. The study included in the Ontario database all women who underwent an oral glucose test at 50 g during pregnancy between 24 and 28 weeks of gestation and who gave birth between July 2007 and December 2015.
Gestational diabetes was defined as a plasma glucose concentration ≥200 mg / dl within 1 hour after challenge (11.1 mmol / L) or a result between 140 mg / dl and 195 mg / dl (7 mg / dl). , 8 and 11.0 mmol / l) with a diagnosis of diabetes at the hospital delivery record. Participants were divided into 6 equal groups based on glucose test results: ≤ 86 mg / dL at 89 mg / dL (4.8 – 4.9 mmol / L;) at 100 mg / dL ( 5.5 mmol / L) 100-115 mg / l dL (5.6 to 6.2 mmol / L); 115-125 mg / dL (6.3 to 6.9 mmol / L) 126-143 mg / dL (7.0 to 7.9 mmol / L); and ≥145 mg / dL (8.0 mmol / L.)
The primary endpoint was cardiovascular disease (a combination of hospitalization for myocardial infarction, acute coronary syndrome, stroke, coronary artery bypbad grafting, graft, percutaneous coronary intervention or carotid endarterectomy). All women have been followed since indexed pregnancy until the occurrence of cardiovascular disease, death, migration or September 30, 2017, whichever comes first.
259,164 women were identified as eligible for this study: 13,609 had gestational diabetes and 245,555 women did not have gestational diabetes. Women were followed for a median of 3.9 years (IQR 2.8 to 5.6) for the development of cardiovascular disease. Each 1 mmol / L increase in the result of the glycemic challenge test was badociated with a 13% higher risk of cardiovascular disease (after adjusting for age, ethnicity, income, and age). of rurality, adjusted risk ratio [HR] 1 · 13, 95% CI 1 · 04-1 · 22). This relationship persisted after excluding women with gestational diabetes (1 · 14, 1 · 01-1 · 28). In women without gestational diabetes, those with an abnormal glucose test result (140 mg / dL) (≥ 7.8 mmol / L) and those with a result of 130 mg / dL. and 140 mg / dL ((7.2 and 7.7 mmol / L) had an increased risk of cardiovascular disease (HR 1 · 94, 95% CI: 1.29-2.22, and 1.65, 0. 99 -2 · 76, respectively), compared to those with a result of 128 mg / dL (7 · 1 mmol / L) or less (overall p = 0.003).
In the group of women without gestational diabetes, the CV risk was higher in patients with an abnormal glucose test at 140 mg / dL. (≥ 7.8 mmol / L), but the cardiovascular risk was also increased in patients whose blood glucose was at the upper limit of normal
"Glucose screening in pregnant women performed as part of current obstetric practices offers the ability to identify future risks. [for CV disease] both those with gestational diabetes and those clinically clbadified as not having gestational diabetes, "the researchers concluded.
Pearls of practice
- Glucose screening during pregnancy can help identify future cardiovascular risk in women with and without gestational diabetes.
- Each 1 mmol / L increase in the result of the glycemic challenge test was badociated with a 13% higher risk of cardiovascular disease
- The relationship between gestational glucose and the risk of cardiovascular disease that results from it extends to normal.
Retnakaran R, Shah BR. Glucose Screening During Pregnancy and the Future Risk of Cardiovascular Disease in Women: Population Retrospective Cohort Study [published online March 27, 2019]. Lancet Diabetes Endocrinol. doi: 10.1016 / S2213-8587 (19) 30077-4
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