Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy

TY - JOUR

T1 - Gestational Diabetes Mellitus and Renal Function

T2 - A Prospective Study With 9- to 16-Year Follow-up After Pregnancy

AU - Rawal, Shristi

AU - Olsen, Sjurdur F

AU - Grunnet, Louise G

AU - Ma, Ronald C

AU - Hinkle, Stefanie N

AU - Granström, Charlotta

AU - Wu, Jing

AU - Yeung, Edwina

AU - Mills, James L

AU - Zhu, Yeyi

AU - Bao, Wei

AU - Ley, Sylvia H

AU - Hu, Frank B

AU - Damm, Peter

AU - Vaag, Allan

AU - Tsai, Michael Y

AU - Zhang, Cuilin

N1 - © 2018 by the American Diabetes Association.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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 b-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 b = 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.

AB - 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 b-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 b = 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.

KW - Adult

KW - Creatinine/urine

KW - Denmark/epidemiology

KW - Diabetes, Gestational/blood

KW - Female

KW - Follow-Up Studies

KW - Glomerular Filtration Rate

KW - Humans

KW - Hypertension/epidemiology

KW - Kidney/physiopathology

KW - Kidney Diseases/epidemiology

KW - Kidney Function Tests

KW - Longitudinal Studies

KW - Postpartum Period/physiology

KW - Pregnancy

KW - Renal Insufficiency, Chronic/epidemiology

KW - Risk Factors

U2 - 10.2337/dc17-2629

DO - 10.2337/dc17-2629

M3 - Journal article

C2 - 29728364

SN - 1935-5548

VL - 41

SP - 1378

EP - 1384

JO - Diabetes Care

JF - Diabetes Care

IS - 7

ER -