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Glucose intolerance during Pregnancy linked with Diabetes

Pregnant women should be wary of their glucose levels, as a recent retrospective and population-based study revealed. Even mild glucose intolerance in pregnancy, though it hasn’t reached the level of gestational diabetes, could modestly predict future cardiovascular risk.

Dr. Ravi Retnakan and Dr. Baiju Shah from the University of Toronto explained that women with mild glucose intolerance had a 19 percent higher risk of cardiovascular disease over the subsequent 12.3 years than those without glucose intolerance (P = 0.03) They also added that those found to have gestational diabetes had an even higher future cardiovascular risk compared with normoglycemic women (adjusted hazard ratio 1.66, P < 0.001). “It is advisable that both groups of women would undergo close cardiovascular surveillance,” they wrote.

Moreover, the researchers strongly emphasized that doctors should note even mild degrees of glucose dysregulation in pregnancy as they could strongly predict future diabetes risk.

Using administrative and universal healthcare insurance databases in Ontario, the researchers collected the glucose outcomes for women aged 20 to 49 who gave birth from 1994 through 1998, excluding those with pregestational diabetes. Standard obstetric care in Canada requires women to be screened during their late second trimester with a 50g glucose challenge test. If the results are abnormal, they’re referred for a diagnostic oral glucose tolerance test.

Of the 349,977 women who were not prescribed with a diagnostic test—suggesting normal glucose challenge test results—the rate of cardiovascular events was 1.9 per 10,000 person-years over 12.3 years of follow-up. This was close to the rate of cardiovascular events (2.3 events per 10,000 person-years) observed among women who had the oral glucose tolerance test. The study also noted that the 13,888 women who were diagnosed with gestational diabetes recorded a rate of 4.2 per 10,000 person years.

“The absolute risk for women with gestational diabetes was 0.16% higher than for women without an oral glucose tolerance test. It was 0.05% higher for those who received an oral glucose tolerance test but did not have gestational diabetes,” the researchers said. “Together with the relatively low underlying cardiovascular risk and longtime frame over which macrovascular disease develops in this population, these results suggest that diabetes and vascular disease may develop in parallel, rather than diabetes coming first in these women.”

Furthermore, editorialists Dr. J. Kennedy Cruickshank, MB, and Dr. Moulinath Banerjee, PhD, both of Manchester Royal Infirmary at the University of Manchester in England, suggested that the subclinical blood vessel changes in these young women may be more important than glycemia itself.

“The study was limited by lack of data on lipid levels and other postpartum cardiovascular risk factors, as well as possible misclassification bias since referral for a glucose tolerance test was used as a surrogate for an abnormal glucose screening test as opposed to having the results of the actual screening test,” they noted.

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