Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated with Coronary Artery Calcium in Women During Midlife- the CARDIA Study

Gestational diabetes (GD) is a cause of early-onset and increased risk of type 2 diabetes, which is a strong risk factor for cardiovascular disease (CVD). However, there is less knowledge on whether attaining normoglycemia can reduce the excess CVD risk associated with GD history. The author Erica P. Gunderson and colleagues (2021) conducted research titled “Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated with Coronary Artery Calcium in Women During Midlife- the CARDIA Study” published in the journal of American Heart Association. The summary of this study is below:

Objective:

To investigate whether GD history and glucose tolerance after pregnancy is associated with coronary artery calcification (CAC) in women.

Method:

Data of white adults aged 18 to 30 years at baseline (1985–1986) was obtained from the Coronary Artery Risk Development in Young Adults (CARDIA) study. 1133 women were included, who had ≥1 singleton birth during follow up, GD status, baseline glucose tolerance testing and up to 5 times during 25 years, and CAC measurements recorded from 1 or more follow up examinations at years 15, 20, and 25. Non-contrast cardiac computed tomography was used to measure CAC.

Findings:

The study reports that sustained normoglycemia post-pregnancy was associated with an elevated risk of CAC among women with GD history. Independent of the sociodemographic, clinical, and lifestyle behavioral risk factors; women with past GD are at ≈2 times higher risk for developing CAC than women without GD and with normoglycemia. Additionally, traditional risk factors (i.e. LDL-C and total cholesterol, and smoking) for atherosclerosis don’t vary by glucose tolerance status among the women in GD groups. This suggests that apart from glucose tolerance GD history may adversely affect CVD risk. In contrast to women with previous GD, weight gain was inversely correlated with glucose tolerance in women without GD.
Hence, these findings highlight that women with a previous history of GD may need additional screening along with the testing of glycemia and that a history of GD should be included in women’s CVD risk calculations.

Limitation:

The authors acknowledge that the study failed to establish whether higher CAC preceded the onset of GD or overt diabetes before year 15 as no CAC measurements before pregnancy were recorded.

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