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Diabetes

Poster Session 1

(346) HDP and GDM and Predicted Risk of Maternal Cardiovascular Disease 10-14 Years after Delivery

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: To determine whether hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are associated with a higher 10- and 30-year predicted risk of atherosclerotic cardiovascular disease (ASCVD), as quantified by the Framingham Risk Score 10-14 years after delivery.

Study Design: A secondary analysis from the prospective Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study. The exposure (expressed as a multiple dichotomous variable) was HDP alone, GDM alone, or both HDP and GDM, compared with none of these (reference). The primary outcomes were high predicted 10- and 30-year ASCVD risk (composite of fatal and non-fatal coronary heart disease and stroke). We used the Framingham Risk Score defined as >7.5% at 10 years and >20% at 30 years per current guidelines. Secondarily, we examined predicted ASCVD risk as a continuous measure. Modified Poisson and linear regression models adjusted for baseline covariates: field center, age, BMI, height, smoking and alcohol use, and parity, all measured at the OGTT during pregnancy.

Results: Of 4,432 assessed individuals, the median age was 30.5 and the median BMI was 26.5 at baseline. A total of 8.2% (n=364) developed HDP alone, 11.2% (n=497) developed GDM alone, and 2.5% (N=112) developed both HDP and GDM. At 10-14 years after delivery (median 11.6), individuals with HDP alone (aRR: 1.02; 95% CI: 1.01-1.04) and GDM alone (aRR: 1.02; 95% CI: 1.01-1.04) were at higher predicted 10-year ASCVD risk compared with those with neither HDP nor GDM. Individuals with HDP alone (aRR: 1.01; 95% CI: 1.01-1.03), GDM alone (aRR:1.04; 95% CI: 1.02-1.06), and both HDP and GDM (95% CI: 1.06; 95% CI: 1.01-1.10) were at higher predicted risk of 30-year CVD compared with those with neither HDP nor GDM. These results were similar when modeling ASCVD risk as a continuous percentage (TABLE).

Conclusion:

Pregnant individuals with HDP and GDM in the HAPO FUS cohort who were 10-14 years after delivery were more likely to be at high predicted risk of ASCVD.