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Cardio Diabetes Medicine 2017 79

Gestational Diabetes Mellitus

and Cardiovascular Disease

Prof. Dr. Sidhartha Das, MD,FRCP(Glasg),FRCP(Edin),FRCP(London)
Senior Consultant in Medicine & Diabetes, Dean and Principal,
S.C.B.Medical College and Hospital, Cuttack-753007, Odisha

Dr. Mrs. Sujata Misra, MD., FICOG.,

Senior Consultant in Obst. & Gyn.
Associate Prof. P.G.Department of Obst. & Gyn. S.C.B.Medical College and Hospital,
Cuttack-753007, Odisha

Abstract a higher prevalence of CVD was noted 29.9 years
Women with gestational diabetes mellitus (GDM) after the index pregnancy in332 women with a his-
are at a greater risk of type 2 diabetes mellitus and tory of GDM ( adjusted OR: 1.85; 95% CI: 1.21.2.82),
cardiovascular disease in later life. With the growing irrespective of associated type II diabetes (OR: 1.56;
prevalence of GDM , it is inevitable that the inci- 95% CI: 1.002-2.43).. In comparison to pregnant wom-
dence of women with cardiovascular disease (CVD) en with normal glucose tolerance, women with GDM
will be on the rise. Hence , it is imperative that screen- were seen to have an adjusted hazard ratio of 1.66
ing, follow up , and treatment strategies should be in ( 95% CI: 1.30-2.13)for CVD ( acute myocardial infarc-
place to control the disorders created by the triad of tion, coronary bypass, coronary angioplasty, stroke,
pregnancy, obesity and GDM. This will help to contain carotid end arterectomy.). In pregnant women with an
the increased incidence of CVD in women in future. abnormal glucose test same was 1.19(955 CI:1.02-1.39).
Even women with mild hyperglycemia in pregnancy,
Introduction not amount in to GDM are at an increased risk for
CVS. But, the highest incidence of CVD in women
Pregnancy, per se, is a hyperinsulinemic state . De- with a history of GDM is seen in those subsequently
creasing insulin sensitivity (increasing insulin resis- developed type II diabetes mellitus. 3
tance ) with increasing gestational age is a physio-
logical process designed to provide glucose to the Common CVD Risk factors
fetus. This is a prerequisite for fetal growth and de-
1
velopment. The increased insulin resistance is due to The potential new markers for of CVD in women with
the placental hormones such as human placental lac- GDM include hypertension, Dyslipidemia and Meta-
togen, human placental growth hormone, estrogen, bolic syndrome.
progesterone and cortiosol which are antagonize Hypertension: Women with a history of GDM are at a
the action of insulin. Most women can combat this greater risk of developing hypertension as compared
physiological insulin resistance and remain euglyce- to women without a history of GDm (46.8% vs37% ;
mic. The few who cannot cope up with this increasing p<0.001). In addition , hypertension is diagnosed at
insulin resistance manifest as cases of Gestational an earlier age in the former as compared to the latter
diabetes Mellitus (GDM). Hence, GDM is defined as grpoup (40+/- 1.0 vs 47.8 +- 0.9 years;p<0.001). 4
of glucose intolerance developing or first recognised
during pregnancy with values of blood sugar which Goueslard et al have studied 62,958 women with
are not clearly indicative of overt diabetes. 2 GDM and 1,452,429 women without a history of GDM
with a follow uo for seven years . They have reported
Women with a history of GDM are at a higher risk of that GDM was associated with a higher risk of hy-
overt cardiovascular disease in later life. GDM alone pertension with an adjusted OR of 2.92 (2.77-3.08). 5
contributes to this risk ; independent of subsequent
type II diabetes mellitus. In a cross sectional study, Dyslipidemia: Carr et al have reported that women

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