This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints, Permissions and Rights Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heitritter, S. M. Articles by Seely, E. W. Search for Related Content PubMed PubMed Citation Articles by Heitritter, S. M. Articles by Seely, E. W. Related Collections Cardiovascular Endocrinology Diabetes and Insulin Female Endocrinology

Subclinical Inflammation and Vascular Dysfunction in Women with Previous Gestational Diabetes Mellitus

Division of Endocrinology, Diabetes, and Hypertension (S.M.H., N.S.-O, E.W.S.), Divisions of General Internal Medicine and Women’s Health (C.G.S.), Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts 02115; and Cardiovascular Engineering, Inc. (G.F.M.), Holliston, Massachusetts 01746

Address all correspondence and requests for reprints to: Shannon Heitritter, M.D., Division of Endocrinology, Diabetes, and Hypertension, 221 Longwood Avenue, Boston, Massachusetts 02115. E-mail: sheitritter{at}partners.org.

Context: A history of gestational diabetes (GDM) significantly increases the risk of developing type 2 diabetes, an independent risk factor for cardiovascular disease (CVD). It is not known whether nondiabetic women with prior GDM are also at increased risk of CVD.

Objective: The aim of this study was to compare biochemical and hemodynamic surrogate markers of CVD in nondiabetic women with and without a history of GDM who were at least 1 yr post delivery.

Design: This was a single center cross-sectional study.

Setting: The study was performed in an academic referral center.

Subjects: Forty-eight premenopausal healthy women with a history of GDM (n = 25) or a history of normal pregnancy (n = 23) were studied in the follicular phase of the menstrual cycle.

Main Outcome Measures: The main outcome measures were: 1) inflammatory markers associated with CVD including C-reactive protein, IL-6, and plasminogen activator inhibitor-1; 2) the adipokine adiponectin; and 3) conduit vessel stiffness.

Results: When compared to normal controls, women with prior GDM had higher mean levels of C-reactive protein (3.58 ± 3.86 vs. 0.52 ± 0.16 mg/liter; P < 0.001), IL-6 (1.81 ± 1.04 vs. 0.99 ± 0.52 pg/ml; P = 0.001), plasminogen activator inhibitor-1 (29.6 ± 17.6 vs. 16.5 ± 14.0 ng/ml; P = 0.001), and lower levels of adiponectin (8.9 ± 3.9 vs. 15.9 ± 7.3 µg/ml; P = 0.001). Women with prior GDM also had significantly (P 0.04) increased peripheral vascular resistance (1658 ± 290 vs. 1462 ± 340 dyne·sec/cm⁵), decreased stroke volume (65 ± 13 vs. 75 ± 14 ml/beat), and decreased cardiac output (70 ± 12 vs. 74 ± 13 ml/sec) when compared to controls, after adjusting for body mass index.

Conclusions: Nondiabetic women with prior GDM have evidence of subclinical inflammation, hypoadiponectinemia, and early vascular dysfunction; this population may be at increased risk of developing CVD.

This article has been cited by other articles:

				R. Retnakaran and B. R. Shah Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study Can. Med. Assoc. J., September 15, 2009; 181(6-7): 371 - 376. [Abstract] [Full Text] [PDF]

				M Ethier-Chiasson, J-C Forest, Y Giguere, A Masse, C Marseille-Tremblay, E Levy, and J Lafond Modulation of placental protein expression of OLR1: implication in pregnancy-related disorders or pathologies Reproduction, October 1, 2008; 136(4): 491 - 502. [Abstract] [Full Text] [PDF]

				C. Kim, Y. J. Cheng, and G. L. Beckles Inflammation Among Women With a History of Gestational Diabetes Mellitus and Diagnosed Diabetes in the Third National Health and Nutrition Examination Survey Diabetes Care, July 1, 2008; 31(7): 1386 - 1388. [Abstract] [Full Text] [PDF]

				J. E. Friedman, J. P. Kirwan, M. Jing, L. Presley, and P. M. Catalano Increased Skeletal Muscle Tumor Necrosis Factor-{alpha} and Impaired Insulin Signaling Persist in Obese Women With Gestational Diabetes Mellitus 1 Year Postpartum Diabetes, March 1, 2008; 57(3): 606 - 613. [Abstract] [Full Text] [PDF]

				L. A. Barbour, C. E. McCurdy, T. L. Hernandez, J. P. Kirwan, P. M. Catalano, and J. E. Friedman Cellular Mechanisms for Insulin Resistance in Normal Pregnancy and Gestational Diabetes Diabetes Care, July 1, 2007; 30(Supplement_2): S112 - S119. [Full Text] [PDF]

				J. L. Kitzmiller, L. Dang-Kilduff, and M. M. Taslimi Gestational Diabetes After Delivery: Short-term management and long-term risks Diabetes Care, July 1, 2007; 30(Supplement_2): S225 - S235. [Full Text] [PDF]

				M. W. Carpenter Gestational Diabetes, Pregnancy Hypertension, and Late Vascular Disease Diabetes Care, July 1, 2007; 30(Supplement_2): S246 - S250. [Full Text] [PDF]

				J. Bronsky, M. Karpisek, E. Bronska, M. Pechova, B. Jancikova, H. Kotolova, D. Stejskal, R. Prusa, and J. Nevoral Adiponectin, Adipocyte Fatty Acid Binding Protein, and Epidermal Fatty Acid Binding Protein: Proteins Newly Identified in Human Breast Milk Clin. Chem., September 1, 2006; 52(9): 1763 - 1770. [Abstract] [Full Text] [PDF]