Department of Epidemiology, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Curr Diab Rep. 2024 Nov;24(11):244-255. doi: 10.1007/s11892-024-01552-4. Epub 2024 Sep 4.
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications worldwide and the prevalence is continuously rising globally. Importantly, GDM is not an isolated complication of pregnancy. Growing evidence suggests that individuals with GDM, compared to those without GDM, have an increased risk of subsequent type 2 diabetes (T2D) and cardiovascular diseases (CVD). Substantial racial and ethnic disparities exist in the risk of GDM. However, the role of race and ethnicity in the progression from GDM to T2D and CVD remains unclear. The purpose of the current review is to summarize recent research about GDM and its life-course impacts on cardiometabolic health, including 1) the peak time of developing T2D and CVD risks after GDM, 2) the racial and ethnic disparities in the risk cardiometabolic diseases after GDM, 3) the biological plausibility and underlying mechanisms, and 4) recommendations for screening and prevention of cardiometabolic diseases among individuals with GDM, collectively to provide an updated review to guide future research.
Growing evidence has indicated that individuals with GDM had greater risks of T2D (7.4 to 9.6 times), hypertension (78% higher), and CDV events (74% higher) after GDM than their non-GDM counterparts. More recently, a few studies also suggested that GDM could slightly increase the risk of mortality. Available evidence suggests that key CVD risk factors such as blood pressure, plasma glucose, and lipids levels are all elevated as early as < 1 year postpartum in individuals with GDM. The risk of T2D and hypertension is likely to reach a peak between 3-6 years after the index pregnancy with GDM compared to normal glycemia pregnancy. Cumulative evidence also suggests that the risk of cardiometabolic diseases including T2D, hypertension, and CVD events after GDM varies by race and ethnicity. However, whether the risk is higher in certain racial and ethnic groups and whether the pattern may vary by the postpartum cardiometabolic outcome of interest remain unclear. The underlying mechanisms linking GDM and subsequent T2D and CVD are complex, often involving multiple pathways and their interactions, with the specific mechanisms varying by individuals of different racial and ethnic backgrounds. Diabetes and CVD risk screening among individuals with GDM should be initiated early during postpartum and continue, if possible, frequently. Unfortunately, adherence to postpartum glucose testing with either obstetrician or primary care providers remained poor among individuals with GDM. A life-course perspective may provide critical information to address clinical and public health gaps in postpartum screening and interventions for preventing T2D and CVD risks in individuals with GDM. Future research investigating the racial- and ethnic-specific risk of progression from GDM to cardiometabolic diseases and the role of multi-domain factors including lifestyle, biological, and socio-contextual factors are warranted to inform tailored and culture-appropriate interventions for high-risk subpopulations. Further, examining the barriers to postpartum glucose testing among individuals with GDM is crucial for the effective prevention of cardiometabolic diseases and for enhancing life-long health.
妊娠糖尿病（GDM）是全球最常见的妊娠并发症之一，其患病率在全球范围内持续上升。重要的是，GDM 不仅仅是妊娠的一个孤立并发症。越来越多的证据表明，与没有 GDM 的人相比，患有 GDM 的人患 2 型糖尿病（T2D）和心血管疾病（CVD）的风险增加。在 GDM 的风险方面存在显著的种族和民族差异。然而，种族和民族在 GDM 向 T2D 和 CVD 进展中的作用仍不清楚。本综述的目的是总结最近关于 GDM 及其对心脏代谢健康的终生影响的研究，包括 1）GDM 后发生 T2D 和 CVD 风险的高峰时间，2）GDM 后发生心脏代谢疾病的种族和民族差异，3）生物学合理性和潜在机制，以及 4）GDM 个体的心脏代谢疾病筛查和预防建议，旨在提供更新的综述以指导未来的研究。
越来越多的证据表明，与非 GDM 个体相比，GDM 个体在 GDM 后发生 T2D（7.4 至 9.6 倍）、高血压（高 78%）和 CVD 事件（高 74%）的风险更高。最近，一些研究还表明，GDM 可能会略微增加死亡风险。现有证据表明，关键的 CVD 风险因素，如血压、血浆葡萄糖和血脂水平，在 GDM 个体中早在产后<1 年内就升高。与正常血糖妊娠相比，GDM 索引妊娠后 3-6 年，T2D 和高血压的风险可能达到峰值。累积证据还表明，GDM 后包括 T2D、高血压和 CVD 事件在内的心脏代谢疾病的风险因种族和民族而异。然而，某些种族和民族群体的风险是否更高，以及这种模式是否因产后心脏代谢结局的不同而不同，仍不清楚。将 GDM 与随后的 T2D 和 CVD 联系起来的潜在机制很复杂，通常涉及多个途径及其相互作用，具体机制因不同种族和民族背景的个体而异。应在产后期间尽早开始对 GDM 个体进行糖尿病和 CVD 风险筛查，如果可能的话，应经常进行。不幸的是，GDM 个体与产科医生或初级保健提供者的产后葡萄糖检测依从性仍然很差。从生命历程的角度来看，可能会提供关键信息，以解决产后筛查和干预方面的临床和公共卫生差距，从而预防 GDM 个体的 T2D 和 CVD 风险。有必要进行研究，以调查从 GDM 进展为心脏代谢疾病的种族和民族特异性风险，以及包括生活方式、生物学和社会-情境因素在内的多领域因素的作用，以便为高危亚人群提供量身定制和文化适宜的干预措施。此外，检查 GDM 个体产后葡萄糖检测的障碍对于有效预防心脏代谢疾病和增强终身健康至关重要。
