Gestational diabetes mellitus and renal function: A prospective study with 9-to 16-year follow-up after pregnancy

Shristi Rawal, Sjurdur F. Olsen, Louise G. Grunnet, Ronald C. Ma, Stefanie N. Hinkle, Charlotta Granström, Jing Wu, Edwina Yeung, James L. Mills, Yeyi Zhu, Wei Bao, Sylvia H. Ley, Frank B. Hu, Peter Damm, Allan Vaag, Michael Y. Tsai, Cuilin Zhang

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

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 b-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 b = 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.

Original languageEnglish (US)
Pages (from-to)1378-1384
Number of pages7
JournalDiabetes care
Volume41
Issue number7
DOIs
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (contract numbers HHSN275201000020C, HHSN275201500003C, HHSN275201300026I, HHSN275201100002I). Financial support for the DNBC was received from the Innovation Fund Denmark (grant numbers 09-067124 and 11-115923, Centre for Fetal Programming), March of Dimes Birth Defects Foundation (6-FY-96-0240, 6-FY97-0553, 6-FY97-0521, 6-FY00-407), Health Foundation (11/263-96), Heart Foundation (96-2-4-83-22450), and European Union (FP7-289346-EarlyNutrition).

Publisher Copyright:
© 2018 by the American Diabetes Association.

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