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

doi:10.2337/dc17-2629

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

Department of Clinical Medicine

10 Citations (Scopus)

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 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.

Original language	English
Journal	Diabetes Care. Supplement
Volume	41
Issue number	7
Pages (from-to)	1378-1384
Number of pages	7
ISSN	1064-9131
DOIs	https://doi.org/10.2337/dc17-2629
Publication status	Published - 1 Jul 2018

Keywords

Adult
Creatinine/urine
Denmark/epidemiology
Diabetes, Gestational/blood
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Hypertension/epidemiology
Kidney/physiopathology
Kidney Diseases/epidemiology
Kidney Function Tests
Longitudinal Studies
Postpartum Period/physiology
Pregnancy
Renal Insufficiency, Chronic/epidemiology
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Rawal, S., Olsen, S. F., Grunnet, L. G., Ma, R. C., Hinkle, S. N., Granström, C., Wu, J., Yeung, E., Mills, J. L., Zhu, Y., Bao, W., Ley, S. H., Hu, F. B., Damm, P., Vaag, A., Tsai, M. Y., & Zhang, C. (2018). Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy. Diabetes Care. Supplement, 41(7), 1378-1384. https://doi.org/10.2337/dc17-2629

Rawal, S, Olsen, SF, Grunnet, LG, Ma, RC, Hinkle, SN, Granström, C, Wu, J, Yeung, E, Mills, JL, Zhu, Y, Bao, W, Ley, SH, Hu, FB, Damm, P, Vaag, A, Tsai, MY & Zhang, C 2018, 'Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy', Diabetes Care. Supplement, vol. 41, no. 7, pp. 1378-1384. https://doi.org/10.2337/dc17-2629

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

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{\textquoteright}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.",

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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

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 - 1064-9131

VL - 41

SP - 1378

EP - 1384

JO - Diabetes Care. Supplement

JF - Diabetes Care. Supplement

IS - 7

ER -

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

Abstract

Keywords

UN SDGs

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