Long-term cardiovascular outcomes of gestational diabetes mellitus: a prospective population-based UK Biobank study


      Previous studies suggested that a history of gestational diabetes mellitus (GDM) can be a risk factor for subsequent atherosclerotic cardiovascular disease. However, there is a paucity of information regarding diverse cardiovascular outcomes in middle-aged women who have a history of GDM. The purpose of the current study is to examine whether women with a history of GDM have an increased risk for long-term overall cardiovascular outcomes.

      Study Design

      The UK Biobank is a prospective cohort study that recruited >500,000 adult residents between 2006 and 2010 with ongoing follow-up. We included 219,330 women who reported at least one live birth and compared the new incidence of diverse cardiovascular outcomes according to the history of GDM by multivariable Cox proportional hazard models. In addition, causal mediation analysis was performed to examine the contribution of well-known risk factors to observed risk.


      During follow-up, a total of 13,094 women (6.0%) developed new overall cardiovascular outcomes. Women with a history of GDM had an increased risk for total cardiovascular outcomes (7.80 vs 5.81 new incidences per 1,000 women-year between women with a history of GDM and those without, p< 0.001) Specifically, women with a history of GDM had increased risk for the new occurrence of coronary artery disease (HR 1.330, p=0.003), myocardial infarction (HR 1.678, p< 0.001), ischemic stroke (HR 1.696, p=0.004), peripheral artery disease (HR 1.064, p=0.007), heart failure (HR 1.426, p=0.013), mitral regurgitation (HR 2.276, p< 0.001), and atrial fibrillation/flutter (HR 1.474, p< 0.001), after adjustment for confounding variables. In mediation analysis, subsequent overt diabetes explained 23%, hypertension explained 11%, and dyslipidemia explained 10% of the association between GDM and overall cardiovascular outcome.


      GDM is associated with an increased risk of more diverse cardiovascular outcomes than previously considered, and conventional risk factors such as subsequent diabetes, hypertension, and dyslipidemia partially contributed to this relationship.
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