Long-term risk of diabetes following hypertensive disorders of pregnancy: A retrospective cohort study.

BACKGROUND

The impact of varying degrees of pregnancy-induced hypertension (PIH) on the risk of developing diabetes later in life is currently unknown.

AIM

To assess the long-term risks of type 2 diabetes mellitus (T2DM), prediabetes, and mortality that are associated with hypertensive disorders of pregnancy.

METHODS

This retrospective cohort study used the TriNetX United States Collaborative Network to examine outcomes, especially T2DM, prediabetes and mortality, related to hypertensive disorders of pregnancy in females aged 21-45. Participants had no history of hypertension or diabetes before pregnancy or before 20 weeks of gestation. Propensity score matching was applied to balance covariates such as gestational diabetes, polycystic ovarian syndrome, chronic kidney disease, hyperlipidemia, overweight/obesity, nicotine dependence, alcohol abuse, and healthcare utilization. This ensured comparability between groups and reduced potential confounding in outcome evaluation.

RESULTS

This study included 318544 females aged 21-45 with and without PIH. Females with PIH had higher risks of T2DM [hazard ratio (HR): 1.907, 95% confidence interval (CI): 1.821-1.998), prediabetes (HR: 1.610, 95%CI: 1.537-1.687), and mortality (HR: 1.501, 95%CI: 1.361-1.655) over a follow-up of up to 18 years. Incidence rates for T2DM, prediabetes, and mortality were 3.2%, 2.7%, and 0.6%, respectively. Subgroup analyses showed that the presence of gestational hypertension, preeclampsia, and eclampsia increased risks across all outcomes. Persistent hypertension beyond 12 weeks postpartum was linked to more than a 3-fold increase in mortality. Preventative aspirin use during pregnancy did not reduce the risks of T2DM, prediabetes, or mortality among those with PIH.

CONCLUSION

PIH significantly increases the long-term risks of T2DM, prediabetes, and mortality, highlighting the urgent need for improved long-term management strategies to enhance overall health in such individuals.