Glucose Test During Pregnancy Can Predict Future Heart Disease

Sept. 10, 2009 - PRLog -- It has been well known that glucose abnormalities in pregnancy are predictive of a greater risk of diabetes later in life. However, a recent study in the Canadian Medical Association Journal by Retnakaran and Shah has now shown that mild glucose abnormalities in pregnancy, even if not diagnostic of gestational diabetes, can also predict an increase in the risk of heart disease later in life. Heart disease is the number one killer of women in the United States.

The American College of Obstetrics and Gynecology recommends that glucose screening be performed in all pregnant women in the third trimester of pregnancy using a 50 gram glucose challenge test. If results are abnormal, a 3 hour oral glucose tolerance test using 100 grams of glucose follows with the results determining which women are diabetic and which are not. Diabetic pregnant women are considered higher risk pregnancies and are closely monitored with finger stick glucose results for the remainder of the pregnancy with medications added as needed. Most commonly the diabetes disappears at delivery and many of these women are lost to follow-up care. This new study is critical in the conclusion that those women with glucose abnormalities, no matter how slight, should be followed for cardiovascular disease for the remainder of their lives.

The study was retrospective and included all women between the ages of 20 and 49 in Ontario, Canada who delivered between 1994 to 1998 and did not have a preexisting diagnoses of diabetes. Women were followed for 12.3 years after delivery. The results showed greatest risk in women with gestational diabetes, 4.2 vs 2.3, in women who failed the 1 hour but passed the 3 hour test, and 1.9 rate per 10,000 person-years in women who passed both tests. This demonstrated that women with even mild glucose abnormalities had an increased risk of future cardiovascular disease compared to the normal population but not as great as the gestational diabetics who clearly had higher vascular mortality.

The authors also suggest that the diabetes does not occur prior to the heart disease but rather that the two develop in parallel. There may be some damage to the vascular system that is not clinically apparent by the time the diabetes testing is positive. Correcting the sugar levels in diabetic patients fails to reduce the mortality or change the cardiovascular risk rates adding credence to the fact that the vascular damage has occurred prior to the high blood sugar levels. Still, controlling the sugar levels in the early stages of pregnancy is important to prevent congenital malformations and also to prevent excessive growth of the fetus. It is also important in the mother to allow for proper wound healing and the prevention of infections. In addition, women who had borderline glucose abnormalities and those who were diabetic were more obese than normoglycemic women and perhaps it is the obesity causing the hyperglycemia, which can cause an increase in cardiovascular risk.
In conclusion, continued surveillance after delivery in all women who had any glucose abnormalities during their pregnancy is essential. Special emphasis on modifications of other risk factors (obesity, smoking, hypertension, cholesterol) in this population may have a beneficial effect on future prevention of heart disease in this new high risk group.

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