Gestational diabetes & diabetes in pregnancy
Association of Gestational Diabetes With Subsequent Long-Term Risk of Mortality
Authors' conclusion
Results of this cohort study suggest that participants who reported a history of gestational diabetes exhibited a small but elevated risk of subsequent mortality over 30 years. The findings emphasize the importance of considering gestational diabetes as a critical factor in later-life mortality risk.
Study context
- Population
- US female nurses aged 25 to 42 years with at least 1 pregnancy (≥6 months) at 18 years or older; mean (SD) age 34.9 (4.7) years, BMI 24.1 (4.7) at baseline
- Participants
- 91,426 parous participants
- Exposure
- History of GDM vs no history of GDM
- Outcome
- Total and cause-specific mortality (HRs by Cox proportional hazards regression)
- Follow-up
- 30 years (1989-2019)
Methodological detailsNurses' Health Study II, 30-year follow-up, Data analyzed May 1, 2022, to May 25, 2023
- Nurses' Health Study II
- 30-year follow-up
- Data analyzed May 1, 2022, to May 25, 2023
Main finding
As reported in the abstract
Total mortality · 2 609 753 person-years follow-up
GDM
1.74 per 1000 person-years
No GDM
1.49 per 1000 person-years
GDM vs No GDMHazard ratio (95% CI)
Total mortality
1.28(1.13–1.44)
Additionally adjusted for potential confounders and lifestyle factors during reproductive life span
1.25(1.11–1.41)
- Crude mortality with GDM
- absolute difference 0.25 per 1000 person-years
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CVD mortality | 1.59 (1.03–2.47) | |
| Cancer mortalityOnly evident among participants who later developed T2D | 0.76 (0.59–0.98) | |
| Total mortality by GDM subgroupGDM in ≥2 pregnanciesvs No GDM | 1.48 (0.99–2.19) | |
| Total mortality by GDM subgroupGDM in initial and subsequent pregnanciesvs No GDM | 1.71 (1.11–2.63) | |
| Total mortality by GDM subgroupGDM with hypertensive disorders in pregnancyvs No GDM | 1.80 (1.21–2.67) | |
| Total mortality by GDM subgroupGDM with preterm birthvs No GDM | 2.46 (1.66–3.64) | |
| Total mortality by GDM subgroupGDM with low birth weightvs No GDM | 2.11 (1.21–3.68) | |
| 0.20.5125Hazard ratio (log scale) |
- CVD mortality: 255 CVD deaths
- Cancer mortality: 1397 cancer deaths
Total mortality by GDM subgroup
- Association persisted regardless of subsequent T2D and was more robust with less healthy lifestyles
Original publication
Association of Gestational Diabetes With Subsequent Long-Term Risk of Mortality. JAMA Intern Med. Published 1 November 2023. doi:10.
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