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Prediction of risk of maternal cardiovascular disease among Asian Indian women after gestational diabetes mellitus during 3-5 years of postpartum follow-up

Published onJun 16, 2023
Prediction of risk of maternal cardiovascular disease among Asian Indian women after gestational diabetes mellitus during 3-5 years of postpartum follow-up

Background: Gestational diabetes mellitus (GDM) has been associated with increased risk of cardiovascular disease (CVD). Despite the recommendations for CVD risk assessment during postpartum follow-up in GDM women, it is often overlooked. There is a paucity of evidence from south Asia about the prevalence of CVD risk factors in women with history of GDM. This study aims at estimating the risk factors of CVD and assessment of 10-year CVD risk using Framingham Risk Score-CVD (FRS-CVD) among Asian Indian women 3-5 years post GDM delivery. Methods: The STratification of Risk of Diabetes in Early pregnancy (STRiDE) cohort included Asian Indian (n=2703) women who were screened for GDM using IADPSG criteria. The STRiDE-Follow up study (STR-FUS) is an ongoing longitudinal study of the STRiDE cohort screened for diabetes and CVD risk factors. So far screening of 500 participants (GDM-151, non-GDM-349) is completed. The diagnosis of dyslipidaemia and dysglycaemia were using National Cholesterol Education Programme (NCEP) guidelines and 2020 American Diabetes Association (ADA) criteria respectively. Results: The overall prevalence of dysglycaemia and dyslipidaemia were 16.8% and 66.0% at a mean follow up of 4.3 years post-delivery. The descriptive statistics of cardiovascular risk factors showed that the GDM group had significantly higher triglycerides (122±73 vs 95±39; p<0.001) and total cholesterol/high density lipoprotein ratio (TC/HDL) (3.8±0.88 vs 3.6±0.70; p<0.017) than non-GDM group. The women in the GDM and non-GDM group had similar age and slightly higher blood pressure. Prevalence of hypertriglyceridemia (22.5% vs 8.9%, p<0.001), and TC/HDL ratio (25.2%vs15.2%, p=0.008) were significantly higher in the GDM group compared to the non-GDM group. Prevalence of dyslipidaemia was significantly higher in women who had postpartum dysglycaemia than normoglycemic women (88.1% vs 61.5%, p<0.001). All GDM women were classified to have low 10-year CVD risk (10-year risk <10%) by FRS-CVD risk prediction. Conclusion: Asian Indian women with history of GDM have significant derangement of cardiometabolic parameters post-delivery. Despite this, the traditional FRS-CVD has classified these women to be low risk for 10-year CVD. Our findings highlight the need for a population specific CVD risk score for women with history of GDM.

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