Previous gestational diabetes is independently associated with increased carotid intima-media thickness, similarly to metabolic syndrome - a case control study.
BACKGROUND
Women with previous gestational diabetes mellitus (pGDM) face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT) from young women with pGDM to those with metabolic syndrome (MS) and to healthy controls (CG) to verify whether a past history of pGDM could be independently associated with increased cIMT.


METHODS
This is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc), and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity.


RESULTS
cIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P < 0.05) except for the right common carotid. The pGDM women showed similar cIMT measurements to MS in all sites of measurements, except for the left carotid bifurcation, where it was significantly higher than MS (P < 0.001). In a multivariate analysis which included classical cardiovascular risk factors and was adjusted for confounders, pGDM was shown to be independently associated with increased composite cIMT (P < 0.01). The pGDM without risk factors further showed similar cIMT to MS (P > 0.05) and an increased cIMT when compared to controls (P < 0.05).


CONCLUSIONS
Previous GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.
Laboratory of Endocrinology, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brazil.
Claudia Maria Vilas
CM
Freire
Felipe Batista Lima
FB
Barbosa
Maria Cristina C
MC
de Almeida
Paulo Augusto Carvalho
PA
Miranda
Márcia Melo
MM
Barbosa
Anelise Impeliziere
AI
Nogueira
Milena Moreira
MM
Guimarães
Maria do Carmo Pereira
Mdo C
Nunes
Antônio
A
Ribeiro-Oliveira
D000328:Adult; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001938:Brazil; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016014:Linear Models; D008055:Lipids / Q000097:blood; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D018608:Ultrasonography, Doppler
D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids