- Gestational diabetes during pregnancy can cause short-term health issues for the mother as well as the baby.
- Researchers, however, say gestational diabetes can lead to a wide array of long-term cardiovascular health issues.
- Experts say medical profession needs to focus more on these long-term effects.
- They urge people who are pregnant to maintain a nutritious, well-balanced diet as well as a regular exercise routine.
Almost 30 years ago, while pregnant with my second daughter, I was diagnosed with gestational diabetes.
It freaked me out at the time, but through healthy eating and smart interventions, I was able to avoid insulin.
I’ve barely thought of it since. I’m not even sure I always remember to mention it in health surveys.
A study being presented at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting, suggests I should have been paying more attention, and so too should all women, either before any pregnancy or after one that involved gestational diabetes.
In their study, the researchers say gestational diabetes is associated with an increased risk of more diverse cardiovascular outcomes later in life than previously thought.
Using participants in the UK Biobank, a database containing health information from an estimated half a million participants, researchers looked at the cardiovascular health of nearly 220,000 women who had delivered at least one baby between 2006 and 2010.
Results showed that slightly more than 13,000 women — or 6 percent — developed cardiovascular problems. It also showed that women with a history of gestational diabetes were at greater risk of a variety of cardiovascular problems, and that risk increased with age.
“Until now, the long-term outcome of GDM (gestational diabetes) in the elderly population has not been studied,” Dr. Seung Mi Lee, a specialist in the Department of Obstetrics & Gynecology at the Seoul National University College of Medicine and lead author of the study, told Healthline.
“GDM increased the risk of diverse cardiovascular outcomes, including heart failure, mitral regurgitation, and atrial fibrillation in [older] women,” she added.
For practitioners in the field, this data backs up something they’ve been pushing all along: that a GDM diagnosis should be followed through life.
“This does not surprise me or any of my colleagues in any way,” Dr. Tamika Cross, FACOG, the author of “What a Doctor Looks Like,” told Healthline.
“It’s good to have specific data,” she added. “When counseling, we always talk about long term. But it’s vague and general. Now we can be more specific.”
Cross said that many forget the diagnosis as time goes on.
“I think calling it a ‘diabetes of pregnancy’ makes (patients) focus that way,” she said. “There’s a feeling of ‘after I deliver, it goes away.’”
OB-GYNs have long been fighting that.
“As OB-GYNs, we have long known that women with gestational diabetes have a significant risk of developing type 2 diabetes later in life,” Dr. David Lubetkin, FACOG, the medical director of Boca Midwifery in Boca Raton, Florida, told Healthline.
“This study puts a quantifiable number on the risk, and shows how important it is to help identify those at risk for developing type 2 diabetes in the future, and even identifying those women who [had pre-existing diabetes] prior to pregnancy unbeknownst to them,” he added.
Cross said she hopes the data helps women considering pregnancy to take proactive steps to avoid GDM ahead of time.
She also hopes to keep these women tuned in to what they should do post-pregnancy for long-term health.
Human nature does play a role here.
Short-term outcomes can affect the baby, so they often get attention. Long-term is more difficult to spotlight, Cross said.
“We are always talking about controlling the sugars short term,” she said. “It’s the here and now that gets our attention.”
Risks from GDM such as a larger baby, birth trauma, and other complications make it easier for most women to hone in on things like changing their diet, exercising more, and keeping track of blood sugars.
“I don’t want to gloss over the importance of that short term,” she said, “but the long term is important, too.”
Cross points out that once you’ve been diagnosed with GDM, it’s something to monitor for life.
“Even if you are well controlled during pregnancy and don’t end up needing insulin, this is a lifelong thing,” she said.
Cross advises women considering pregnancy to increase their health and fitness regime first, as much as they can.
“As cliché as it sounds, a good regimen of exercise, diet, and maintaining a healthy weight can help,” she said.
A majority of those Cross sees in her clinic with GDM are overweight, usually with a body mass index (BMI) above 30.
But, she added, there are genetic components as well, which means digging into your family history to find evidence of any type of diabetes is a good practice as well.
Cross said you can still start an improved daily routine even if you’re surprised by an unexpected pregnancy.
“[It’s] not too late. Start with a regime to help you move toward (better overall health and fitness) as soon as you can,” she said.
Should you be diagnosed, Lubetkin said, ask your OB-GYN to do follow-up testing and give you guidance.
“I always perform a 75-gram glucose challenge on my [patients with] postpartum gestational [diabete] to identify those who might have persistent impaired carbohydrate metabolism,” he said.
“The best way to prevent these potential cardiac issues is to encourage a healthy lifestyle and make sure that [women with gestational diabetes] understand their potential future risk,” he added.
Lee is encouraged by the data, but hopes to see an even deeper dive into the topic.
“Further studies are needed to determine whether these pathophysiologic mechanisms might also be applicable to the relationship between GDM and diverse cardiovascular outcomes,” she said.
“The result of the current study evokes the next question: whether women with GDM history may benefit from cardiovascular preventive strategies, such as intensive lifestyle modification, pharmacologic treatment including statin, or aspirin therapy in midlife,” she added.