Journal article
Associations between gestational diabetes and cardiovascular disease largely operate independently of postpartum causal pathways: a population-based cohort study in England
- Abstract:
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Background
Gestational diabetes mellitus (GDM) is associated with increased risk of developing type 2 diabetes and cardiovascular disease (CVD). Here we explore whether the associations are mediated by development of type 2 diabetes, and other CVD risk factors.
Methods
The Exploring Long-term Outcomes following PrEgnancy affected by GDM (ELOPE-GDM) study is a population-based matched cohort study, containing 43,572 records of women diagnosed with GDM matched with 174,288 records of non-GDM women. We used Cox proportional hazards models to assess the risk of GDM on CVD, ischemic heart disease (IHD) and stroke/TIA and quantified the proportions of these effects mediated by the progression to type 2 diabetes, hypertension, or dyslipidaemia using causal mediation analysis.
Results
There were significant associations between GDM and CVD; (adjusted HR 1.58 (95% CI 1.27 to 1.97)), IHD (1.83 (1.35 to 2.49)) and stoke/TIA (1.43 (1.06 to 1.95)). There were strong associations between GDM and developing type 2 diabetes (OR 13.90 (95% CI 13.19 to 14.51)), hypertension (1.87 (1.781to 1.92)), dyslipidaemia (1.80 (1.76 to 1.84)), or any of these postpartum mediators (1.67 (1.63 to 1.71). However, most of the effect of GDM on CVD was not attributed to the overall mediating effects of type 2 diabetes (36% (95% CI 8% to 64%)), hypertension (15% (5% to 24%)) dyslipidaemia (37% (18% to 55%)), or a combination of these conditions (32% (11% to 53%) which developed after pregnancy.
Conclusion
These findings emphasise the need for comprehensive cardio metabolic screening following a pregnancy affected by GDM.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.2MB, Terms of use)
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- Publisher copy:
- 10.1111/dom.70210
Authors
+ National Institute for Health Research
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- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- NIHR200172
+ Diabetes Research and Wellness Foundation
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- Funder identifier:
- https://ror.org/02bz4qp22
- Grant:
- PP/2021/NA
- Publisher:
- Wiley
- Journal:
- Diabetes, Obesity and Metabolism More from this journal
- Volume:
- 28
- Issue:
- 1
- Pages:
- 417-426
- Publication date:
- 2025-11-05
- Acceptance date:
- 2025-10-08
- DOI:
- EISSN:
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1463-1326
- ISSN:
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1462-8902
- Language:
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English
- Keywords:
- Pubs id:
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2298931
- Local pid:
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pubs:2298931
- Deposit date:
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2025-10-09
- ARK identifier:
Terms of use
- Copyright holder:
- Astbury et al
- Copyright date:
- 2025
- Rights statement:
- © 2025 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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