TY - JOUR

T1 - Gestational Diabetes Mellitus and Renal Function

T2 - A Prospective Study With 9- to 16-Year Follow-up After Pregnancy

AU - Rawal, Shristi

AU - Olsen, Sjurdur F

AU - Grunnet, Louise G

AU - Ma, Ronald C

AU - Hinkle, Stefanie N

AU - Granström, Charlotta

AU - Wu, Jing

AU - Yeung, Edwina

AU - Mills, James L

AU - Zhu, Yeyi

AU - Bao, Wei

AU - Ley, Sylvia H

AU - Hu, Frank B

AU - Damm, Peter

AU - Vaag, Allan

AU - Tsai, Michael Y

AU - Zhang, Cuilin

N1 - © 2018 by the American Diabetes Association.

PY - 2018/7

Y1 - 2018/7

N2 - OBJECTIVE: To examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy.RESEARCH DESIGN AND METHODS: In the Diabetes & Women's Health (DWH) study (2012-2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived.RESULTS: Compared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR.CONCLUSIONS: Women who develop GDM in pregnancy were more likely to show increased eGFR levels 9-16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.

AB - OBJECTIVE: To examine whether gestational diabetes mellitus (GDM), independent of subsequent diabetes, is an early risk factor for renal impairment long term after the index pregnancy.RESEARCH DESIGN AND METHODS: In the Diabetes & Women's Health (DWH) study (2012-2016), we examined the independent and joint associations of GDM and subsequent diabetes with long-term renal function among 607 women with and 619 women without GDM in the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). At median follow-up of 13 years after the index pregnancy, serum creatinine (mg/dL) and urinary albumin (mg/L) and creatinine (mg/dL) were measured, from which estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (UACR) (mg/g) were derived.RESULTS: Compared with women without GDM or subsequent diabetes, women with a GDM history had significantly higher eGFR even if they had not subsequently developed diabetes (adjusted β-coefficient [95% CI] = 3.3 [1.7, 5.0]). Women who had a GDM history and later developed diabetes (n = 183) also had significantly higher UACR [exponent β = 1.3 [95% CI 1.1, 1.6]) and an increased risk of elevated UACR (≥20 mg/g) [adjusted relative risk [95% CI] = 2.3 [1.1, 5.9]) compared with women with neither. After adjusting for potential confounders including prepregnancy BMI and hypertension, GDM without subsequent diabetes was not related to UACR.CONCLUSIONS: Women who develop GDM in pregnancy were more likely to show increased eGFR levels 9-16 years postpartum, which could indicate early stages of glomerular hyperfiltration and renal damage. However, only those who subsequently developed diabetes showed overt renal damage as evidenced by elevated UACR.

KW - Adult

KW - Creatinine/urine

KW - Denmark/epidemiology

KW - Diabetes, Gestational/blood

KW - Female

KW - Follow-Up Studies

KW - Glomerular Filtration Rate

KW - Humans

KW - Hypertension/epidemiology

KW - Kidney/physiopathology

KW - Kidney Diseases/epidemiology

KW - Kidney Function Tests

KW - Longitudinal Studies

KW - Postpartum Period/physiology

KW - Pregnancy

KW - Renal Insufficiency, Chronic/epidemiology

KW - Risk Factors

U2 - 10.2337/dc17-2629

DO - 10.2337/dc17-2629

M3 - Journal article

C2 - 29728364

VL - 41

SP - 1378

EP - 1384

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 7

ER -