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Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study
Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-2691-7525
(Clinical Epidemiology and Biostatistics)
Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
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2014 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, no 12, p. 1530-1536Article in journal (Refereed) Published
Abstract [en]

Objective: To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups.

Design: Population-based matched case-control study.

Setting: National Swedish register data from 1991 to 2008.

Population: A total of 2639 women with a cardiovascular event and matched controls.

Methods: Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role.

Main outcome measures: Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease.

Results: The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07-2.14), 2.23 (2.01-2.48) for smoking, 1.98 (1.71-2.29) for obesity and 5.10 (3.18-8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI 25, with an odds ratio of 2.39 (1.39-4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13-3.52).

Conclusions: In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 121, no 12, p. 1530-1536
Keywords [en]
Body mass index, cardiovascular disease, gestational diabetes mellitus
National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-39455DOI: 10.1111/1471-0528.12754ISI: 000344372600013PubMedID: 24762194Scopus ID: 2-s2.0-84899041720OAI: oai:DiVA.org:oru-39455DiVA, id: diva2:770356
Note

Funding Agency:

Research Committee of Örebro County Council, Sweden

Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2019-04-24Bibliographically approved

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Fadl, HelenaMontgomery, ScottHanson, Ulf

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Fadl, HelenaÖstlund, IngridMontgomery, ScottHanson, Ulf
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Örebro University HospitalSchool of Health and Medical Sciences, Örebro University, SwedenSchool of Health Sciences
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British Journal of Obstetrics and Gynecology
Endocrinology and DiabetesObstetrics, Gynecology and Reproductive Medicine

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