Gestational Diabetes, Prepregnancy Overweight Causes Concern for Future Health Issues Prepregnancy Overweight and Gestational Diabetes as Determinants of Subsequent Diabetes and Hypertension After 20- Year Follow-Up

Objective: To evaluate the roles of prepregnancy obesity and gestational diabetes mellitus as determinants of risks for subsequent diabetes and hypertension during 20 years of follow-up. Design: Prospective, population-based study. Participants: 9362 women delivering singleton infants between 1985 and 1986. Methods: On 20-year follow-up, registry-based data was used to ascertain diagnoses of diabetes and hypertension. Of participants, 5 study groups were comprised: (1)normal weight women with gestational diabetes, (2)overweight women with gestational diabetes, (3) normal weight women with risk factors for diabetes with normal oral glucose tolerance tests (OGTT), (4) overweight women with risk factors for diabetes with normal OGTT, and (5) women with no risk factors for gestational diabetes. Results: Accumulated incidence of diabetes and hypertension, 20 years post-index delivery, was 1.3% and 7.5%, respectively. Those who were overweight prepregnancy with an abnormal OGTT had the highest risk for subsequent diabetes (25.9%) and for hypertension (44.4%). Prepregnancy overweight with a normal OGTT was associated with higher risk for diabetes and hypertension, and in normal weight women, gestational diabetes indicated risk for subsequent diabetes but not hypertension. Conclusions: Prepregnancy overweight and gestational diabetes are both risk factors for subsequent development of diabetes and hypertension, but prepregnancy overweight in and of itself is an essential risk factor. Reviewer's Comments: This was a well-designed and well-conducted long-term study on the contribution of prepregnancy overweight and gestational diabetes to the future development of diabetes and hypertension. The combination of the 2 yields astoundingly high risks for later development of diabetes and hypertension, but as this article points out, prepregnancy overweight in and of itself is a significant and important risk factor for 2 important chronic diseases of adulthood. (Reviewer-Berel Held, MD).