News & Research

    University of Kentucky Research Foundation, Lexington, Kentucky

Cardiometabolic outcomes following pregnancy complicated by gestational diabetes

General Research Subject: Gestational Diabetes

Focus: Clinical Diabetes, Pregnancy, Epidemiology

Type of Grant: Clinical Translational Research

Project Start Date: July 1, 2009

Project End Date: June 30, 2012

Research Description

Women with a history of gestational diabetes (GDM) are at substantial risk for long-term cardiometabolic abnormalities, including type 2 diabetes. Currently, recommendations include only postpartum glucose screening for women with a recent history of GDM with follow-up at least every three years. How women with GDM should be followed long term is not clear. Given the association of GDM with cardiovascular disease and diabetes, other screening measures may provide earlier recognition of components of metabolic syndrome. The proposed study will prospectively follow a group of women who experience GDM beginning in the postpartum period. An expanded screening will be done and will include blood pressure testing, waist-hip ratio, and lipid testing in addition to the currently recommended glucose tolerance testing. Women will be evaluated annually. In addition, women will undergo testing for subclinical vascular disease using non-invasive methods of endothelial function testing. Other mediators of cardiometabolic disease such as markers of endothelial function, inflammation, and insulin resistance will be measured. The knowledge gained from this study will provide much needed information regarding the testing of women with GDM postpartum. In addition, results will be a critical step to improve the understanding of the clinical mechanisms of progression to cardiometabolic disease and thereby enable better prevention, diagnosis, and treatment for this group of patients at high risk.

Reseacher Profile

What area of diabetes research does your project cover?  What role will this particular project play in preventing, treating and/or curing diabetes? 

This project focuses on the long-term consequences for women with a history of glucose intolerance complicating pregnancy or gestational diabetes (GDM). Women with a history of GDM are at an increased risk for long-term cardiometabolic abnormalities including the very high risk of developing type 2 diabetes.  Recommendations include screening in the postpartum period, but exactly how these women should be followed over time is unclear. Multiple cardiometabolic abnormalities have been demonstrated in these patients months to years later but studies have varied with respect to time-frame following diabetes and studies employed. Our goal is to compare cardiovascular and metabolic risk factors in a prospective and sustainable cohort of women with and without a recent history of GDM in order to improve understanding of the clinical mechanisms of progression to cardiometabolic disease and thereby enable better prevention, diagnosis, and treatment. The cohort study proposed will follow recently postpartum women who experienced GDM using a unique expanded annual screening methodology. Knowledge gained in this cohort study will provide much needed information regarding the type of testing and frequency of testing that women with GDM should undergo following pregnancy. Expansion of the postpartum testing currently employed offers the opportunity to identify women at an earlier stage of metabolic dysfunction that may permit intervention to delay or prevent disease.

If a person with diabetes were to ask you how your project will help them in the future, how would you respond? 

Currently, women with gestational diabetes are encouraged to undergo glucose tolerance testing postpartum. Expansion of the postpartum testing to include other markers of cardiometabolic dysfunction may offer the opportunity to identify women at an earlier stage of metabolic dysfunction. Screening will include body mass index, waist-hip ratio, blood pressure, fasting lipids, CRP, and other biomarkers of inflammation and endothelial function. Recognition of abnormalities earlier may permit intervention to delay or prevent disease. The establishment of this cohort will be invaluable for prospective data on the progression of cardiometabolic dysfunction in this high risk population. Information gained will be instrumental in the design of further innovative screening, prevention, and treatment trials.

Why is it important for you, personally, to become involved in diabetes research?  What role will this award play in your research efforts? 

I have been involved extensively with the treatment aspect of diabetes and pregnancy. As I counsel women regarding their diagnosis of gestational diabetes, I explain the risks to their health, their babies well being, and their pregnancy in general. The long-term risk to their own health however often becomes lost as the patient places much emphasis on the baby and her pregnancy. At a time in their lives when they are in good health, their high risk of future disease fades into the busy postpartum background.  We have an opportunity to make a difference with education and early recognition in this high-risk group. As we understand the progression of cardiometabolic dysfunction, we can improve our screening programs and perhaps intervene earlier. This award will further my efforts to close the gap between pregnancy and later life disease and improve the hand-off of patients from obstetrics to primary care.

In what direction do you see the future of diabetes research going? 

We have made great strides with recognizing the importance of treating glucose intolerance during pregnancy. As we gain understanding of what the thresholds are for adverse outcomes, treatment guidelines will evolve. Out next big challenge is understanding how to reduce risk in future pregnancies and prevent life-long complications. Women with GDM contribute to  the overall rate of type 2 diabetes. Risk recognition, prevention/delay, and early treatment are imperative in this population.