title: Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis.
abstract: OBJECTIVE
  To examine the association between gestational diabetes mellitus (GDM) and high maternal weight and the risk of development of chronic disease.
  
  
  METHODS
  Women with singleton deliveries between April 1999 and March 2010 in Alberta, Canada, were categorized according to pre-pregnancy weight (overweight ≥ 91 kg) and GDM status. Obstetric and neonatal outcomes, as well as the long-term incidence of maternal diabetes, hypertension and cardiovascular disease were examined.
  
  
  RESULTS
  Of 240 083 women, 213 765 (89%) had no GDM and were not overweight (reference group), 17 587 (7.3%) were overweight only, 7332 (3%) had GDM only and 1399 (0.6%) had GDM and were overweight. Significant differences in Caesarean section rates, induction rates and birthweight were observed across the four groups. During a median follow-up of 5.3 years, diabetes incidence was 36% in the GDM and overweight, 18.8% in the GDM only, 4.8% in the overweight only and 1.1% in the reference group. With respect to hypertension and cardiovascular disease, the GDM and overweight group had the highest rates (26.8% and 3.1%, respectively) and the reference group had the lowest rates (5.8% and 1.0%, respectively). However, rates were similar in the GDM only (14.9% and 1.9%, respectively) and overweight only groups (14.9% and 1.5%, respectively).
  
  
  CONCLUSIONS
  Not surprisingly, the presence of both high maternal weight and GDM compounds the risk of developing diabetes. However, the association between overweight alone and GDM alone and hypertension and cardiovascular disease appears similar suggesting a need for effective interventions to manage both these conditions to improve the health of these patients.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Kaul
authors.forename: A
authors.initials: A
authors.lastname: Savu
authors.forename: K A
authors.initials: KA
authors.lastname: Nerenberg
authors.forename: L E
authors.initials: LE
authors.lastname: Donovan
authors.forename: C L
authors.initials: CL
authors.lastname: Chik
authors.forename: E A
authors.initials: EA
authors.lastname: Ryan
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008137:Longitudinal Studies; D039382:Maternal Nutritional Physiological Phenomena; D008875:Middle Aged; D050177:Overweight / Q000150:complications / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult