Daily Dose: Concomitant Gestational Diabetes, Hypertensive Disorder Raise Long-term Postpartum CVD Risk

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On December 13, 2022, we reported on a study published in JAMA Network Open that estimated the individual and joint associations of gestational hypertensive disorders (GHTD) and gestational diabetes (GD) with incident cardiovascular disease (CVD).

The study

Researchers conducted a population-based cohort study using data from administrative health care databases maintained by the Ministry of Health and Long-Term Care of Ontario. Using access to records of all women in Ontario with a GHTD and/or GD diagnosis and a live birth singleton delivery between July 1, 2007, and March 31, 2018, investigators identified 866 295 stud participants. Diagnostic codes were used to identify eligible participants and exclusion criteria eliminated potential participants with pregravid diabetes, hypertension, or CVD.

The results

During the first 5 years after delivery, the team found no association between co-occurrence of GHTD and GD (aHR, 1.42 [95% CI, 0.78-2.58] p=.25) or GD alone (aHR, 0.80 [95% CI, 0.60-1.06]) and incident CVD. Compared with no GHTD or GD during this time period, however, investigators did observe an association between isolated GHTD and risk of incident CVD (aHR, 1.90 [95% CI, 1.51-2.35]). Also, after full adjustment for confounding variables including postpartum hypertension and postpartum diabetes, isolated GHTD was associated with a greater risk for incident CVD than isolated GD (aHR, 2.32; 95% CI, 1.62-3.30; P < .001) in a direct comparison.

When the research team assessed CVD risk after the initial 5 years following index birth, they found that isolated GHTD (aHR, 1.41 [95% CI, 1.12-1.76]) and co-occurrence of GHTD and GD (aHR, 2.43 [95% CI, 1.60-3.67] p<.001) were each associated with a higher risk of incident CVD vs no GHTD and no GD.

Clinical implications

“In this cohort study, GHTD was associated with a high risk of CVD post partum, and the co-occurrence of GD and GHTD was associated with a much greater postpartum CVD risk. These findings suggest that CVD preventive care is particularly needed in the aftermath of combined GD and GHTD."

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