Gestational diabetes mellitus alone in the absence of subsequent diabetes is associated with microalbuminuria: results from the Kidney Early Evaluation Program (KEEP).
OBJECTIVE
Women with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.


METHODS
This cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1-2 and 3-5 was assessed using logistic regression.


RESULTS
Of 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1-2 (multivariate odds ratio 1.54 [95% CI 1.16-2.05]) similar to the odds for women with overt diabetes (1.68 [1.55-1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1-2 but not CKD stages 3-5 among women with GDM.


CONCLUSIONS
Women with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1-2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.
Bomback
Andrew S
AS
Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York, USA. asb68@columbia.edu
Rekhtman
Yelena
Y
Whaley-Connell
Adam T
AT
Kshirsagar
Abhijit V
AV
Sowers
James R
JR
Chen
Shu-Cheng
SC
Li
Suying
S
Chinnaiyan
Kavitha M
KM
Bakris
George L
GL
McCullough
Peter A
PA
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000209:etiology*; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy
Diabetes Care. 2001 Oct;24(10):1764-9
11574439
CMAJ. 2008 Jul 29;179(3):229-34
18663202
Diabetes Care. 2008 Dec;31(12):2344-8
18796622
Am J Kidney Dis. 2010 Mar;55(3 Suppl 2):S1-3
20172443
Am J Kidney Dis. 2008 Apr;51(4 Suppl 2):S3-12
18359405
CMAJ. 2009 Sep 15;181(6-7):371-6
19703913
Fertil Steril. 2010 Mar 1;93(4):1248-54
19147138
Lancet. 2009 May 23;373(9677):1773-9
19465232
J Clin Endocrinol Metab. 2005 Jul;90(7):3983-8
15840749
Diabetes Care. 2004 Jul;27(7):1721-7
15220253
J Clin Endocrinol Metab. 2005 Jul;90(7):4004-10
15840755
Acta Obstet Gynecol Scand. 1995 May;74(5):356-60
7778427
J Intern Med. 2004 May;255(5):588-94
15078501
JAMA. 2005 Apr 6;293(13):1609-16
15811980
Diabetes Care. 2008 May;31(5):e32
18445712
Diabetes. 1998 May;47(5):793-800
9588452
Am J Med. 2009 Mar;122(3):207-214.e4
19272478
J Clin Endocrinol Metab. 2010 Feb;95(2):670-7
19926711
Am J Kidney Dis. 2010 Mar;55(3 Suppl 2):S4-S14
20172446
J Hypertens. 2006 Jun;24(6):1157-63
16685216
Diabetes Care. 2008 Aug;31(8):1668-9
18487472
Am J Kidney Dis. 2010 Mar;55(3 Suppl 2):S15-22
20172444