Increased risk for microvascular complications among women with gestational diabetes in the third trimester

Baiju R Shah; Denice S Feig; Elaine Herer; Michelle A Hladunewich; Alexander Kiss; Radha P Kohly; Lorraine L Lipscombe; Paul M Yip; David Z Cherney

doi:10.1016/j.diabres.2021.109068

Increased risk for microvascular complications among women with gestational diabetes in the third trimester

Diabetes Res Clin Pract. 2021 Oct:180:109068. doi: 10.1016/j.diabres.2021.109068. Epub 2021 Sep 23.

Authors

Baiju R Shah¹, Denice S Feig², Elaine Herer³, Michelle A Hladunewich⁴, Alexander Kiss⁵, Radha P Kohly⁶, Lorraine L Lipscombe⁷, Paul M Yip⁸, David Z Cherney⁹

Affiliations

¹ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada. Electronic address: baiju.shah@ices.on.ca.
² Department of Medicine, University of Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada.
³ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada.
⁴ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada.
⁵ Sunnybrook Research Institute, Toronto, ON, Canada.
⁶ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, ON, Canada.
⁷ Department of Medicine, University of Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada.
⁸ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.
⁹ Department of Medicine, University of Toronto, ON, Canada; University Health Network, Toronto, ON, Canada.

PMID: 34563584
DOI: 10.1016/j.diabres.2021.109068

Abstract

Aims: The risk of microvascular disease has been thought to commence with the onset of overt diabetes. Women with gestational diabetes have only had a short-term exposure to frank hyperglycemia, but, due to underlying β-cell dysfunction, they may also have had long-term exposure to mild degrees of hyperglycemia. The aim of the study was to determine whether women with gestational diabetes are at increased risk for microalbuminuria and retinopathy compared to women with normal glucose tolerance in pregnancy.

Methods: We recruited women aged ≥ 25 years with singleton pregnancies at 32 to 40 weeks' gestational age, with and without gestational diabetes. Women with hypertension, preeclampsia, or pre-gestational diabetes were excluded.

Results: Of 372 women included in the study, 195 had gestational diabetes. The prevalence of microalbuminuria was 15% among those with gestational diabetes versus 6% in those with normal glucose tolerance (adjusted odds ratio 2.4, 95% confidence interval 1.1 to 5.2, p = 0.006). Diastolic blood pressure and HbA1c were associated with microalbuminuria. The prevalence of retinopathy did not differ between groups (10% versus 11%).

Conclusions: Women with gestational diabetes have an increased risk of microalbuminuria in the third trimester, despite having been exposed to only a brief period of overt hyperglycemia.

Keywords: Diagnostic criteria; Gestational diabetes mellitus; Microalbuminuria; Retinopathy.

MeSH terms

Diabetes, Gestational* / epidemiology
Female
Humans
Hyperglycemia*
Pre-Eclampsia*
Pregnancy
Pregnancy Trimester, Third
Risk Factors