Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity.
OBJECTIVE
Previous gestational diabetes (GDM) is a risk factor for type 2 diabetes and increased metabolic risk, but the link with vascular dysfunction is not clear. This study examined vascular function in women 4-10 years after a diagnosis of GDM who had a normal oral glucose tolerance test (OGTT) in the first postpartum year.


METHODS
We studied 90 women with a history of GDM and 59 age-matched controls, examining differences in insulin resistance as measured by the Homeostatic Model Assessment (HOMA-IR) and glucose responses during an OGTT, adiposity, lipid profile and C-reactive protein (CRP). Using pulse wave analysis, we also measured cardiac function, vascular compliance, and systemic vascular resistance.


RESULTS
Women with a history of GDM had higher measures of adiposity (body mass index 28.9 ± 6.5 vs. 26.6 ± 6.9 kg/m(2), P=0.04, waist-hip ratio 0.85 ± 0.06 vs. 0.79 ± 0.07, P<0.001), dyslipidemia (LDL cholesterol 2.78 ± 0.64 vs. 2.41 ± 0.56 mmol/L, P<0.001, total cholesterol: HDL cholesterol 3.93 ± 1.2 vs. 3.21 ± 0.82 mmol/L, P<0.001) and abnormal glucose metabolism (50% vs. 12%, P<0.001). However, there was no difference in CRP, HOMA-IR, or measures of cardiovascular function including pulse rate, pulse pressure, mean arterial pressure, cardiac output, systemic vascular resistance, small and large artery elasticity index. After controlling for adiposity, blood pressure, lipids and CRP, glycemic status did not contribute to vascular function.


CONCLUSIONS
Despite a higher incidence of adiposity, dyslipidemia, and impaired glycemia, women with a history of GDM who had a normal postpartum OGTT did not have impaired vascular function 4-10 years postpartum, when compared to healthy controls.
Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada. Electronic address: olubaniy@ualberta.ca.
Olubukola
O
Ajala
Faculty of Nursing Level 3 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
Louise A
LA
Jensen
Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada.
Edmond
E
Ryan
Division of Endocrinology and Metabolism, Department of Medicine, 9th Floor, Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada.
Constance
C
Chik
D050154:Adiposity; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D016640:Diabetes, Gestational / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D009765:Obesity / Q000453:epidemiology*; D049590:Postpartum Period; D011247:Pregnancy; D012307:Risk Factors; D049629:Waist-Hip Ratio
D001786:Blood Glucose; D008055:Lipids; D002097:C-Reactive Protein
Adiposity; Dyslipidemia; Gestational diabetes; Vascular function