Gestational Diabetes and Incident Heart Failure: A Cohort Study
Research Design and Methods: We conducted a population-based cohort study using information from the Ministry of Health and Long Term Care of Ontario (Canada) health-care administrative databases. We identified all women in Ontario with a GDM diagnosis with a livebirth singleton delivery between July 1, 2007 and March 31, 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization, over a period extending from the index pregnancy until March 31, 2019. The secondary outcome was prevalent peripartum cardiomyopathy (PPCM) at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors.
Results: Among 906,319 eligible women (mean age: 30 years [SD: 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR]: 1.62, 95% CI: 1.28, 2.05), compared to no-GDM. This association remained significant after accounting for chronic kidney disease, post-partum diabetes, hypertension, and coronary artery disease (aHR: 1.39, 95% CI: 1.09, 1.79). GDM increased the odds of PPCM (adjusted odds ratio: 1.83, 95% CI: 1.45, 2.33).
Conclusions: In a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk of HF.