Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy.

Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE

Publication: Alexandria Va : American Diabetes Association
Original Publication: New York, American Diabetes Assn.

Diabetes, Gestational/*epidemiology ; Diabetes, Gestational/*physiopathology ; Kidney/*physiopathology ; Kidney Diseases/*epidemiology; Adult ; Creatinine/urine ; Denmark/epidemiology ; Diabetes, Gestational/blood ; Diabetes, Gestational/rehabilitation ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Hypertension/epidemiology ; Hypertension/etiology ; Hypertension/physiopathology ; Kidney Diseases/physiopathology ; Kidney Function Tests ; Longitudinal Studies ; Postpartum Period/physiology ; Pregnancy ; Renal Insufficiency, Chronic/epidemiology ; Risk Factors

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 m ² ) 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.
(© 2018 by the American Diabetes Association.)

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HHSN275201100002C United States HD NICHD NIH HHS; HHSN275201000020C United States HD NICHD NIH HHS; HHSN275201500003C United States HD NICHD NIH HHS; HHSN275201300026I United States HD NICHD NIH HHS; HHSN275201100002G United States HD NICHD NIH HHS

AYI8EX34EU (Creatinine)

Date Created: 20180506 Date Completed: 20180828 Latest Revision: 20240207

20240207

PMC6014536

10.2337/dc17-2629

29728364