Prevalence of the impaired glucose metabolism and its association with risk factors for coronary artery disease in women with gestational diabetes

https://doi.org/10.1016/j.diabres.2007.10.015Get rights and content

Abstract

Gestational diabetes (GDM) has increased risk of diabetes (DM2), a coronary artery disease (CAD) equivalent. The aim of this study was to determine the prevalence of impaired glucose metabolism (IGM) in GDM and its association with risk factors for CAD. A cohort of 109 women with GDM underwent a glucose tolerance test which classified them into three groups: diabetic (DM2) (fasting glucose (G) ≥126 mg/dl or plasma glucose 2 h (2-h G) ≥200 mg/dl); impaired glucose tolerance (IGT) (G 100–125 mg/dl and/or 2-h G 140–199 mg/dl); and normal (N) (G < 100 mg/dl and/or 2-h < 140 mg/dl). They were compared for pre-gestational (PBMI) and current (CBMI) body mass index, systolic (SBP) and diastolic blood pressure (DBP), G, lipids, fibrinogen and C-reactive protein (hsCRP). Thirty two months after delivery, 17.4% presented DM2, 39.4% IGT and 43.1% were N. PBMI, CBMI, SBP and DBP were significantly higher in the DM2 than N. G was higher in DM2 and IGT. HDL-cholesterol (HDL-C) was higher in the N (p = 0.02) and the triglycerides (TG) were higher in DM2 (p = 0.02). The groups showed significantly different levels of hsCRP (p = 0.002). We conclude that the high prevalence of IGM, overweight/obesity, dyslipidemia and altered inflammatory markers, make GDM a high-risk situation for CAD.

Introduction

Diabetes mellitus (DM2) is a public health problem due to its great prevalence and association to other diseases, particularly cardiovascular disease (CVD) [1].

Patients with gestational diabetes (GDM) or impaired glucose tolerance (IGT) present higher frequencies of DM2 [2], [3]. Many studies show that DM2 and CVD share common antecedents. DM2 is considered as equivalent to coronary artery disease (CAD) [4], [5], one of the main causes of death in diabetes [6], [7], [8]. Finding ways to identify patients at risk for both diseases represents today a great challenge. Conventional risk factors for cardiovascular disease, such as systemic arterial hypertension, obesity, sedentarism, dyslipidemia and, presently, inflammatory markers, are seen as potential tools for this identification [9], [10].

Many epidemiology studies have shown an association between diabetes and inflammatory markers, particularly those related to C-reactive protein (hsCRP). Despite the high variability observed in the associations detected in those studies, which are partly due to differences in adjustment of the models, diagnosis of diabetes and duration of follow-up, markers of inflammation have been suggested as adequate predictors of diabetes mellitus [9], [11]. When prevention and early diagnosis of the disease are available, patients and the society as a whole will be benefited through the implementation of health programs and more aggressive therapies, reducing complications and decreasing morbidity and mortality [12], [13].

This study aims to investigate the prevalence of DM2 and impaired glucose tolerance, as well as their association with risk factors and inflammatory markers for CAD, among women who had GDM. This information should be important in the implementation of health initiatives for adequate secondary prevention of the disease.

Section snippets

Patients and methods

Cohort study with 109 patients who gave birth during the period between 1999 and 2003 and were followed up at the Hospital Padre Jeremias, Cachoeirinha (RS, Brazil), as part of the Day-Hospital Program for women with GDM.

Pre-natal care was initially provided in public health services, and the patients had not been diagnosed as diabetics before the current pregnancy. When GDM was diagnosed or not excluded, pregnant women were referred to the Hospital. After confirmation of the diagnosis by

Results

Mean age of the patients was 35.6 ± 6.6 years. The average period between delivery and end of follow-up was 32.0 ± 15.5 months. The patients had in average 3.35 pregnancies. Mean G was 106.0 ± 26.7 mg/dl, and mean 2-h G was 134.2 ± 43.3 mg/dl. The G was 87.80 mg/dl, 101.18 mg/dl and 139.31 mg/dl in the normal, glucose intolerant and diabetic group, respectively. DM2 and IGT had a prevalence of 17.4 and 39.4%, respectively, showing that 56.8% of the patients presented impaired glucose metabolism (IGM).

Table 1

Discussion

The prevalence of DM2 and IGT observed in this study are in agreement with results previously reported. Coustan et al. observed altered results in glucose tolerance tests in 6% of women with GDM, examined between 0 and 2 years after the last pregnancy, and 13% when examined between 2 and 5 years after giving birth [20]. Cheung and Helmink investigated a group of 102 women with history of GDM and who had given birth up to 8 years before. A prevalence of 29% of DM was observed, and the frequency

Conflict of interest

The authors declare that there is no conflict of interest that would prejudice the impartiality of this scientific work, that all authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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