Gestational Diabetes and Stillbirth Dramatically Up Diabetes Risk

Becky McCall

September 18, 2014

VIENNA — Women with gestational diabetes who also experience the trauma of a stillbirth in the same pregnancy have almost 50 times the likelihood of developing type 2 diabetes postnatally, according to a study from Italy.

It is already known that women with gestational diabetes carry an increased risk of developing type 2 diabetes and cardiovascular disease after pregnancy, but this new research, led by Basilio Pintaudi, MD, from Mario Negri Sud Foundation, Santa Maria Imbaro, Italy, is the first to examine the role of stillbirth in women with gestational diabetes on the risk of developing type 2 diabetes after pregnancy. The researchers also looked at cardiovascular risk in this patient group.

"Our most important finding connects the role of stillbirth in differentiating the risks of type 2 diabetes and cardiovascular disease after pregnancy in women who had gestational diabetes," said Dr. Pintaudi. "We believe there are subclinical factors that link both."

"When we looked at women with gestational diabetes and stillbirth in the same pregnancy, the risk is very high," emphasized Dr. Pintaudi, who presented the findings here at the European Association for the Study of Diabetes 2014 Meeting .

"Pregnancy that is complicated by gestational diabetes mellitus and ends in stillbirth represents a decisive factor in determining the development of type 2 diabetes and future cardiovascular events. For this reason, these women deserve a careful follow-up."

Moderating the session, Annunziata Lapolla, MD, who heads the department of diabetes and pregnancy at the University of Padua, Italy, commented on the link between stillbirth, gestational diabetes, and later development of type 2 diabetes.

"This is really interesting work, because we know that gestational diabetes is a very high risk factor for type 2 diabetes development. The important thing here is that not only is type 2 diabetes higher in these patients and also cardiovascular disease, but the new finding that relates to stillbirth," she remarked.

Stillbirth Doubles Diabetes Risk

Dr. Pintaudi and colleagues drew administrative data on 2.1 million women from 12 local health authorities in Puglia, Italy, during the index period from January 1, 2002 to December 31, 2010.

Women with a diagnosis of gestational diabetes were compared with women without gestational diabetes or type 2 diabetes (normal glucose tolerance during pregnancy). Individuals were also matched for age, antihypertensive treatment, antithrombotic treatment, and local health authority code. In total, 3851 women had gestational diabetes, and these were matched to 11,553 controls without the condition.

The main outcome measures were the development of type 2 diabetes postnatally and hospitalizations for cardiovascular events occurring after a pregnancy complicated by gestational diabetes, with a live birth or a stillbirth.

Over a median follow-up of 5.4 years, the incidence rate of type 2 diabetes in women without gestational diabetes was 2.1 per 1000 women per year; this rose to 54.0 per 1000 women per year among those with gestational diabetes who had a healthy birth; and further still to 115.0 per 1000 women per year among women who experienced both gestational diabetes and stillbirth.

Therefore, the risk of developing type 2 diabetes after pregnancy doubled in women who had experienced stillbirth (irrespective of gestational diabetes); the risk increased 22 times in women with gestational diabetes (irrespective of birth status).

But those who experienced stillbirth in combination with gestational diabetes were 47 times more likely to go on develop type 2 diabetes than women with a normal pregnancy.

Gestational Diabetes and Stillbirth Also Up Risk for CV Events

Regarding hospitalizations for cardiovascular events, the analysis showed that in women who had gestational diabetes, the incidence rate per 1000 person-years across the entire population (with still or healthy birth) was 1.83.

In women who had not been diagnosed with gestational diabetes this rate was 0.76. Effectively, having gestational diabetes doubled the risk of hospitalization for cardiovascular events, at an incidence rate ratio of 2.43.

Having a stillbirth as well as gestational diabetes greatly increased this risk, to 14.80 per 1000 person year, compared with 0.89 in women without gestational diabetes but who still had a stillbirth.

Dr. Lapolla said she suspects there is some link between gestational diabetes, obesity, and the vascular bed that could play a role in the risk of stillbirth and subsequent type 2 diabetes and cardiovascular disease. Unfortunately, the records used in Dr. Pintaudi's study did not feature information on obesity status or body mass index (BMI), she noted.

Postnatal Follow-up Key in Women with Gestational Diabetes

According to Dr. Pintaudi, women with gestational diabetes would benefit from following specific recommendations for postnatal care relevant to their diabetes status.

"A very low percentage of women actually follow recommendations after gestational diabetes. These women require better follow-up to help reduce type 2 diabetes and cardiovascular disease," he concluded.

Drs. Pintaudi and Lapolla have reported no relevant financial relationships.

European Association for the Study of Diabetes 2014 Meeting; September 18, 2014; Vienna, Austria. Abstract 154


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