title: Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence.
abstract: The occurrence of common pregnancy-related medical disorders identifies women at high risk of developing future vascular disease. Systematic reviews of cohort studies demonstrate that gestational diabetes confers a 7-fold risk increase for type 2 diabetes, and preeclampsia confers a 1.8-fold risk increase for type 2 diabetes and 3.4-fold risk increase for hypertension. Gestational diabetes and hypertensive disorders of pregnancy (HDP) increase the risk of premature vascular disease, but the 2-fold risk increase associated with preeclampsia is only partially explained by the development of traditional vascular risk factors. Despite the compelling evidence for gestational diabetes and HDP as vascular risk indicators, there are no published Canadian vascular prevention guidelines that recognize these postpartum women. In contrast, the 2011 American Heart Association guidelines on cardiovascular disease in women include gestational diabetes and HDP in their vascular risk assessment. Studies indicate that the importance surveillance of vascular risk factors in these women after pregnancy is underappreciated by the women themselves and their physicians. Although a prudent diet and physically active lifestyle were demonstrated to reduce diabetes risk in women with a gestational diabetes history in the American Diabetes Prevention Program trial, adoption of these health behaviours is low; qualitative studies confirm a need for tailored strategies that address barriers and provide social support. Further research is also needed on approaches to reduce vascular risk in women with a history of gestational diabetes and HDP. Otherwise, an early window of opportunity for chronic disease prevention in young, high-risk women will be missed.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Nerenberg
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, Québec, Canada; Department of Medicine, McGill University, Montreal, Québec, Canada.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.affiliation: Research Institute of the McGill University Health Centre, Montreal, Québec, Canada; Department of Medicine, McGill University, Montreal, Québec, Canada. Electronic address: kaberi.dasgupta@mcgill.ca.
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
mesh_terms: D001794:Blood Pressure; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index