Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy
Shristi Rawal, Sjurdur F Olsen, Louise G Grunnet, Ronald C Ma, Stefanie N Hinkle, Charlotta Granström, Jing Wu, Edwina Yeung, James L Mills, Yeyi Zhu, Wei Bao, Sylvia H Ley, Frank B Hu, Peter Damm, Allan Vaag, Michael Y Tsai, Cuilin Zhang, Shristi Rawal, Sjurdur F Olsen, Louise G Grunnet, Ronald C Ma, Stefanie N Hinkle, Charlotta Granström, Jing Wu, Edwina Yeung, James L Mills, Yeyi Zhu, Wei Bao, Sylvia H Ley, Frank B Hu, Peter Damm, Allan Vaag, Michael Y Tsai, Cuilin Zhang
Abstract
Objective: To examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy.
Research design and methods: In the Diabetes & Women's Health (DWH) study (2012-2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived.
Results: Compared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR.
Conclusions: Women who develop GDM in pregnancy were more likely to show increased eGFR levels 9-16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.
© 2018 by the American Diabetes Association.
Source: PubMed