Oxidized LDL, insulin resistance and central blood pressure after gestational diabetes mellitus.
BACKGROUND
Gestational diabetes mellitus (GDM) is an indicator of future cardiovascular disease. We investigated whether sensitive biomarkers of increased cardiovascular risk differ between women with and without a history of GDM few years after pregnancy, and whether obesity affects the results.


METHODS
We studied two cohorts - 120 women with a history of GDM and 120 controls, on average 3.7 years after delivery. Circulating concentrations of oxidized low-density lipoprotein (oxLDL) were determined by ELISA. The homeostasis model assessment of insulin resistance (HOMA-IR) index was used to estimate insulin resistance. Central blood pressure (cBP) was measured noninvasively from a radial artery pulse wave. The primary outcomes were possible differences in oxLDL, HOMA-IR or cBP between the groups. Secondly, we investigated the influence of obesity on the results, also using adjusted multiple linear regression analyses.


RESULTS
OxLDL concentrations or cBP did not differ between the two cohorts, but HOMA-IR was significantly higher in women with previous GDM than in controls, 1.3 ± 0.9 (SD) and 1.1 ± 0.9, respectively (p = 0.022). In subgroup analyses, HOMA-IR (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) cBP were significantly higher in obese subgroups compared with non-obese ones. Body mass index was an important determinant of HOMA-IR and cBP in multiple linear regression analyses.


CONCLUSIONS
Over 3 years after delivery, women with GDM were still more insulin-resistant than controls. Obesity turned out to be a more important determinant of insulin resistance and cBP compared with GDM.
School of Medicine, University of Tampere, Tampere, Finland.|Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Tiina
T
Vilmi-Kerälä
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Outi
http://orcid.org/0000-0003-0161-7486
O
Palomäki
VITA Healthcare Services Ltd., Vita Laboratory, Helsinki, Finland.|Department of Bacteriology and Immunology, Medical Faculty, University of Helsinki, Helsinki, Finland.
Päivi
P
Kankkunen
Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Leena
L
Juurinen
School of Medicine, University of Tampere, Tampere, Finland.|Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Jukka
J
Uotila
School of Medicine, University of Tampere, Tampere, Finland.|Department of Emergency Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland.|Linnan Klinikka, Hämeenlinna, Finland.
Ari
A
Palomäki
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001795:Blood Pressure Determination; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000503:physiopathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D016014:Linear Models; D008077:Lipoproteins, LDL / Q000097:blood*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000503:physiopathology; D011247:Pregnancy
D015415:Biomarkers; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein
Central blood pressure; gestational diabetes mellitus; homeostasis model assessment of insulin resistance; obesity; oxidized low-density lipoprotein