Shostrom Derrick C V, Sun Yangbo, Oleson Jacob J, Snetselaar Linda G, Bao Wei
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States.
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States.
Front Endocrinol (Lausanne). 2017 Jun 26;8:144. doi: 10.3389/fendo.2017.00144. eCollection 2017.
Findings from previous studies examining the association between gestational diabetes mellitus (GDM) and subsequent risk of cardiovascular disease (CVD) have been inconsistent and inconclusive. We aimed to examine the associations of a previous history of GDM with risk of CVD and status of cardiovascular risk factors in a nationwide population-based study in the United States.
This study included 8,127 parous women aged 20 years or older in the 2007-2014 cycles of the National Health and Nutrition Examination Survey in the United States. The exposure was self-reported diagnostic history of GDM and the outcomes were self-reported diagnostic history of CVD and measurements of cardiovascular risk factors, including blood pressure and blood lipids. Regression models with sample weights were used to examine the associations of GDM with CVD and cardiovascular risk factors.
Among women with a history of both GDM and CVD, CVD was diagnosed on average 22.9 years after the diagnosis of GDM. After adjustment for demographic, socioeconomic, and lifestyle factors, a history of GDM was associated with 63% higher odds of CVD [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.02, 2.62, -value = 0.04]. Further adjustment for body mass index (BMI) modestly attenuated the association (OR 1.52, 95% CI 0.95, 2.44, -value = 0.08). A history of GDM was significantly associated with lower serum level of HDL-cholesterol (adjusted β-coefficient -3.33, 95% CI -5.17, -1.50, -value ≤ 0.001), but not associated with total cholesterol, LDL-cholesterol, triglycerides, or systolic or diastolic blood pressure. Similarly, the association between a history of GDM and HDL cholesterol was attenuated after additional adjustment for BMI (adjusted β-coefficient -1.68, 95% CI -3.38, 0.03, -value = 0.54).
Women with a previous history of GDM have significantly higher risk for developing CVD and lower serum level of HDL cholesterol, compared to women without a history of GDM. The associations may be explained, at least partly, by BMI.
既往研究中关于妊娠期糖尿病（GDM）与后续心血管疾病（CVD）风险之间关联的结果并不一致且尚无定论。我们旨在在美国一项基于全国人群的研究中，探讨既往GDM病史与CVD风险及心血管危险因素状况之间的关联。
本研究纳入了2007 - 2014年美国国家健康与营养检查调查周期中8127名年龄在20岁及以上的经产妇。暴露因素为自我报告的GDM诊断病史，结局为自我报告的CVD诊断病史以及心血管危险因素的测量值，包括血压和血脂。使用带有样本权重的回归模型来检验GDM与CVD及心血管危险因素之间的关联。
在有GDM和CVD病史的女性中，CVD平均在GDM诊断后22.9年被诊断出来。在调整了人口统计学、社会经济和生活方式因素后，GDM病史与CVD发生几率高63%相关[比值比（OR）1.63，95%置信区间（CI）1.02，2.62，P值 = 0.04]。进一步调整体重指数（BMI）后，这种关联略有减弱（OR 1.52，95% CI 0.95，2.44，P值 = 0.08）。GDM病史与较低的高密度脂蛋白胆固醇（HDL - 胆固醇）血清水平显著相关（调整后的β系数为 - 3.33，95% CI - 5.17， - 1.50，P值≤0.001），但与总胆固醇、低密度脂蛋白胆固醇、甘油三酯或收缩压或舒张压无关。同样，在额外调整BMI后，GDM病史与HDL胆固醇之间的关联减弱（调整后的β系数为 - 1.68，95% CI - 3.38，0.03，P值 = 0.54）。
与无GDM病史的女性相比，有既往GDM病史的女性发生CVD的风险显著更高，且HDL胆固醇血清水平更低。这些关联可能至少部分由BMI来解释。
