Long-term maternal metabolic and cardiovascular phenotypes after a pregnancy complicated by mild gestational diabetes mellitus or obesity

Objective: To evaluate the association of mild gestational diabetes (GDM) and obesity with metabolic and cardiovascular markers 5-10 years after pregnancy. Study Design: This was a secondary analysis of 5-10 year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/HOMA-IR, and cardiovascular markers VEGF, VCAM-1, CD40L, GDF-15, and ST-2. Multivariable linear regression estimated the association of GDM and obesity with biomarkers. Results: Of 951 participants in the parent study, 642(68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences -0.24, 95%CI -0.36 - 0.12 and -0.15, 95%CI -0.28 - 0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference -0.11, 95%CI -0.19 - 0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference -0.42, 95%CI -0.52 - 0.32), but not other biomarkers. Conclusion: Five to ten years after delivery, prior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction.