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Gestational Diabetes, Pregnancy Hypertension, and Late Vascular Disease

From Brown Medical School, Providence, Rhode Island

Address correspondence and reprint requests to Marshall W. Carpenter, MD, Women and Infants Hospital, 101 Dudley St., Providence, RI 02905. E-mail: mcarpenter@wihri.org

Abbreviations: CRP, C-reactive protein • GDM, gestational diabetes mellitus

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Increased understanding of the epidemiologic context, pathophysiology, and treatment efficacy of gestational diabetes mellitus (GDM) has raised corollary questions regarding subsequent morbidities, in addition to diabetes, sustained by patients with this diagnosis. Both hypertension and vascular disease have been examined as conditions that may be predicted by GDM. Obesity and insulin resistance are central attributes of both GDM and the metabolic syndrome. These characteristics and dyslipidemia are associated with endothelial dysfunction, oxidative stress, and overexpression of inflammatory responses, all of which contribute to vascular disease. These associations have significant public health ramifications because of the current epidemic of obesity, affecting individuals of all age-groups. The recent report of Crowther et al. (1) confirming the efficacy of screening for and treatment of mild-to-moderate levels of glucose intolerance in mid-pregnancy in reducing both perinatal and maternal morbidity has set the stage for universal maternal screening and thereby identifies a cohort of young women (as many as 200,000 annually in the U.S.) who may be at risk for subsequent hypertension and vascular disease. Recent trials of exercise and dietary interventions and pharmacological treatments suggest that such interventions may reduce late post-gestational morbidity among women with prior GDM. Consequently, questions about the association of GDM and subsequent hypertension and vascular disease are timely and important.

	NONDIABETIC AND GDM PREGNANCY—

 
Pregnancy produces transient insulin resistance, manifest as elevated postprandial glycemia, fasting hyperlipidemia in the form of increased triglycerides, LDL particles, and free fatty acids and accelerated ketosis. Nondiabetic pregnancy is also associated with increased blood levels of plasminogen activator inhibitor-1, tumor necrosis factor-, and C-reactive protein (CRP), all markers of increased inflammatory response. Despite these metabolic characteristics, pregnancy also induces increased venous capacitance, reduced systemic arterial resistance, and vasodilation associated with a 50% increase in circulating blood volume.

Gravidas with GDM generally demonstrate higher degrees of . . . [Full Text of this Article]

	INSULIN RESISTANCE, GDM, AND GESTATIONAL HYPERTENSION—

 

	SYSTEMIC INFLAMMATION AND GDM—

 

	SUBCLINICAL INFLAMMATION, VASCULAR DYSFUNCTION, AND GDM—

 

	LATE VASCULAR SEQUELAE AFTER PREGNANCY HYPERTENSION—

 

	SUMMARY—

 

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				M. M. Hedderson and A. Ferrara High Blood Pressure Before and During Early Pregnancy Is Associated With an Increased Risk of Gestational Diabetes Mellitus Diabetes Care, December 1, 2008; 31(12): 2362 - 2367. [Abstract] [Full Text] [PDF]