Associations between gestational diabetes and cardiovascular disease largely operate independently of postpartum causal pathways: a population‐based cohort study in England
Author(s)
Astbury, Nerys M
Ripullone, Katherine
Ramakrishnan, Rema
Woodwood, Mark
Hirst, Jane E
Type
Journal Article
Abstract
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 1.27–1.97)), IHD (1.83 (1.35–2.49)) and stroke/TIA (1.43 (1.06–1.95)). There were strong associations between GDM and developing type 2 diabetes (OR 13.90 (95% CI 13.19–14.51)), hypertension (1.87 (1.781–1.92)), dyslipidaemia (1.80 (1.76–1.84)) or any of these postpartum mediators (1.67 (1.63–1.71)). 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%–64%)), hypertension (15% (5%–24%)), dyslipidaemia (37% (18%–55%)) or a combination of these conditions (32% (11%–53%)) which developed after pregnancy.
Conclusion
These findings emphasise the need for comprehensive cardio metabolic screening following a pregnancy affected by GDM.
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 1.27–1.97)), IHD (1.83 (1.35–2.49)) and stroke/TIA (1.43 (1.06–1.95)). There were strong associations between GDM and developing type 2 diabetes (OR 13.90 (95% CI 13.19–14.51)), hypertension (1.87 (1.781–1.92)), dyslipidaemia (1.80 (1.76–1.84)) or any of these postpartum mediators (1.67 (1.63–1.71)). 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%–64%)), hypertension (15% (5%–24%)), dyslipidaemia (37% (18%–55%)) or a combination of these conditions (32% (11%–53%)) which developed after pregnancy.
Conclusion
These findings emphasise the need for comprehensive cardio metabolic screening following a pregnancy affected by GDM.
Date Issued
2025-11-05
Date Acceptance
2025-10-08
Citation
Diabetes, Obesity and Metabolism, 2025, 28 (1), pp.417-426
ISSN
1462-8902
Publisher
Wiley
Start Page
417
End Page
426
Journal / Book Title
Diabetes, Obesity and Metabolism
Volume
28
Issue
1
Copyright 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.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41190372
Subjects
cardiovascular disease
gestational diabetes
population‐based studies
risk factors
risk management
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2025-11-05