Gestational diabetes mellitus and maternal renal function

Monday, Jan 21, 2019

A prospective study in Denmark investigated the long-term influences of gestational diabetes mellitus (GDM) on clinical markers for renal impairment in women.

Reference:

Rawal S, et al. Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy. Diabetes Care. 2018;41(7):1378-1384. Link to the article: http://care.diabetesjournals.org/content/diacare/early/2018/05/03/dc17-2629.full.pdf
 

Other online article that you might be interested in:

Hot science on GDM and health outcome – Feb 2018

Background

  • Increasing evidence implicates that GDM is related to subsequent dyslipidemia, hypertension, vascular dysfunction and other cardiometabolic abnormalities that are risk factors for renal dysfunction
     

Subjects

  • Women with (n = 607) and women without GDM  (n = 619) in the Danish National Birth Cohort index pregnancy (1996-2002)
     

Method

  • The influence of GDM and subsequent diabetes and long-term renal function were examined
  • At 9 to 16 years’ follow up (after the index pregnancy),
    • Serum creatinine (mg/dL) and urinary albumin  (mg/L) and creatinine (mg/dL) were determined
    • Estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were calculated
       

Key Findings

  • Compared with women without a GDM history and subsequent diabetes,
    • Women who had GDM and subsequent diabetes had higher UACR (exponent ß = 1.3 [95% Cl 1.1, 1.6] ) and an elevated risk of increased UACR, ≥ 20 mg/g (adjusted RR = 2.3 [95% Cl 1.1, 5.9])
  • GDM was related to higher eGFR irrespective of diabetes status after the index pregnancy
    • Women with GDM and subsequent diabetes had the highest eGFR and an higher risk for glomerular hyperfiltration versus those without GDM or diabetes at follow-up visits
  • GDM without subsequent diabetes was not associated with UACR after adjustment of potential confounders such as pre-pregnancy BMI and hypertension
     

Conclusion

  • GDM may be a risk factor showing subsequent subclinical renal impairment
    • Women with GDM were more likely to have elevated eGFR, that may indicate early stages of glomerular hyperfiltration and renal damage, at 13 years’ postpartum (median follow-up period)


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