Abstract：
OBJECTIVE: To investigate whether the risk for post-partum cardiovascular diseases (CVD) is driven by gestational diabetes (GDM), by GDM-related risk factors and/or by pre-gestational (Pre-GD) or post-gestational diabetes (Post-GD).
METHODS: Women delivering in Tuscany, Italy in years 2010-2012 (n = 74,720), were identified from certificates of care at delivery and further identified as affected with GDM, Pre-GD or Post-GD through regional administrative databases. Women with GDM, Pre-GD or Post-GD were retrospectively evaluated for risk of post-partum hospitalizations for CVD (myocardial infarction or stroke; n = 728) across years 2013-2021, comparing women with different forms of diabetes to those without diabetes. Risk of CVD was assessed as odds ratio (OR 95% CI), after logistic multivariate models, considering all recorded pre-gestational characteristics as covariates.
RESULTS: The adjusted OR (aOR) for post-partum CVD hospitalizations was not significantly related to GDM itself (aOR: 0.85; 0.64-1.12; p = ns), but increased in women with Pre-GD (aOR: 2.02; 1.09-3.71; p = 0.024) and Post-GD, associated or not to prior GDM (aOR; 4.21; 2.45-7.23 and respectively aOR: 3.80; 2.38-6.05; p < 0.0001 for both). In presence of pre-pregnancy maternal obesity (BMI ≥ 30 kg/m2) the aOR of CVD approximatively doubled (aOR: 1.90; 1.51-2.40); p < 0.0001, independently of GDM and of Post-GD. The adjusted risk of CVD was lower among employed women (aOR: 0.83; 0.70-0.99); p = 0.04 and significantly higher in presence of poorer education levels (aOR: 1.32; 1.11-1.57); p < 0.0001.
CONCLUSIONS: In this population the risk of post-partum CVD was driven by Pre- and Post-GD, not by GDM alone. Pre-gestational obesity represented a major independent risk factor for post-partum CVD.
METHODS: Women delivering in Tuscany, Italy in years 2010-2012 (n = 74,720), were identified from certificates of care at delivery and further identified as affected with GDM, Pre-GD or Post-GD through regional administrative databases. Women with GDM, Pre-GD or Post-GD were retrospectively evaluated for risk of post-partum hospitalizations for CVD (myocardial infarction or stroke; n = 728) across years 2013-2021, comparing women with different forms of diabetes to those without diabetes. Risk of CVD was assessed as odds ratio (OR 95% CI), after logistic multivariate models, considering all recorded pre-gestational characteristics as covariates.
RESULTS: The adjusted OR (aOR) for post-partum CVD hospitalizations was not significantly related to GDM itself (aOR: 0.85; 0.64-1.12; p = ns), but increased in women with Pre-GD (aOR: 2.02; 1.09-3.71; p = 0.024) and Post-GD, associated or not to prior GDM (aOR; 4.21; 2.45-7.23 and respectively aOR: 3.80; 2.38-6.05; p < 0.0001 for both). In presence of pre-pregnancy maternal obesity (BMI ≥ 30 kg/m2) the aOR of CVD approximatively doubled (aOR: 1.90; 1.51-2.40); p < 0.0001, independently of GDM and of Post-GD. The adjusted risk of CVD was lower among employed women (aOR: 0.83; 0.70-0.99); p = 0.04 and significantly higher in presence of poorer education levels (aOR: 1.32; 1.11-1.57); p < 0.0001.
CONCLUSIONS: In this population the risk of post-partum CVD was driven by Pre- and Post-GD, not by GDM alone. Pre-gestational obesity represented a major independent risk factor for post-partum CVD.
摘要：
目的：调查产后心血管疾病（CVD）的风险是否由妊娠期糖尿病（GDM）驱动。由GDM相关的危险因素和/或由孕前（GD前）或妊娠后糖尿病（GD后）。
方法：在托斯卡纳分娩的妇女，2010-2012年意大利（n=74,720），从分娩时的护理证书中确定，并进一步确定为受GDM影响，通过区域管理数据库进行GD前或GD后。GDM女性,在2013-2021年期间，回顾性评估了GD前或GD后因CVD（心肌梗塞或中风；n=728）产后住院的风险，比较了患有不同形式糖尿病的女性与非糖尿病的女性。CVD风险评估为比值比（OR95%CI），在逻辑多元模型之后，将所有记录的孕前特征视为协变量.
结果：产后CVD住院的校正OR（aOR）与GDM本身没有显着相关（aOR：0.85;0.64-1.12;p=ns），但在GD前（aOR：2.02;1.09-3.71;p=0.024）和GD后的女性中有所增加，与先前的GDM相关或不相关(aOR;4.21;2.45-7.23和分别aOR:3.80;2.38-6.05;两者的p<0.0001)。在存在孕前母亲肥胖（BMI≥30kg/m2）的情况下，CVD的aOR大约增加了一倍（aOR：1.90；1.51-2.40）；p<0.0001，与GDM和GD后无关。就业妇女患CVD的调整风险较低(aOR:0.83;0.70-0.99);p=0.04,在教育水平较差的情况下显著较高(aOR:1.32;1.11-1.57);p<0.0001。
结论：在该人群中，产后CVD的风险由GD前和GD后驱动，不仅仅是GDM。孕前肥胖是产后CVD的主要独立危险因素。
方法：在托斯卡纳分娩的妇女，2010-2012年意大利（n=74,720），从分娩时的护理证书中确定，并进一步确定为受GDM影响，通过区域管理数据库进行GD前或GD后。GDM女性,在2013-2021年期间，回顾性评估了GD前或GD后因CVD（心肌梗塞或中风；n=728）产后住院的风险，比较了患有不同形式糖尿病的女性与非糖尿病的女性。CVD风险评估为比值比（OR95%CI），在逻辑多元模型之后，将所有记录的孕前特征视为协变量.
结果：产后CVD住院的校正OR（aOR）与GDM本身没有显着相关（aOR：0.85;0.64-1.12;p=ns），但在GD前（aOR：2.02;1.09-3.71;p=0.024）和GD后的女性中有所增加，与先前的GDM相关或不相关(aOR;4.21;2.45-7.23和分别aOR:3.80;2.38-6.05;两者的p<0.0001)。在存在孕前母亲肥胖（BMI≥30kg/m2）的情况下，CVD的aOR大约增加了一倍（aOR：1.90；1.51-2.40）；p<0.0001，与GDM和GD后无关。就业妇女患CVD的调整风险较低(aOR:0.83;0.70-0.99);p=0.04,在教育水平较差的情况下显著较高(aOR:1.32;1.11-1.57);p<0.0001。
结论：在该人群中，产后CVD的风险由GD前和GD后驱动，不仅仅是GDM。孕前肥胖是产后CVD的主要独立危险因素。
