Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting.

Abstract

BACKGROUND:

Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3-6 years post-partum in urban South Africa.

DESIGN AND METHODS:

A prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3-6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants were re-evaluated for anthropometric measurements, body composition utilizing dual energy X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin, lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models.

RESULTS:

Forty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP group(p<0.001); only 20(43.4%) were aware of their diabetic status in the whole group. The odds(OR, 95% confidence interval(CI)) of progressing to type 2 diabetes(T2DM) and metabolic syndrome(MetS) after correcting for confounders in the HFDP group was 10.5(95% CI 3.7-29.5) and 6.3(95%CI 2.2-18.1), respectively. All visceral fat indices were found to be significantly higher in the HFDP group after adjusting for baseline body mass index. Ten-year estimated cardiovascular risk(FRS) and mean cIMT was statistically higher in the HFDP group(8.46 IQR 4.9-14.4; 0.48 mm IQR 0.44-0.53 respectively) compared to the non-HFDP group(3.48 IQR 2.1-5.7; 0.46mm IQR 0.42-0.50) respectively and this remained significant for FRS but was attenuated for cIMT after correcting for confounders. HIV did not play a role in progression to any of these outcomes.

CONCLUSION:

Women with a history of HFDP have a higher risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.

• Authors: Veronique Nicolaou, Larske Soepnel, Kenneth Huddle, Kerstin Klipstein-Grobusch, Naomi S Levitt, Shane A Norris
• Journal: PloS one (PLoS One) Vol. 17 Issue 2 Pg. e0263529 ( 2022) ISSN: 1932-6203 [Electronic] United States
• PMID: 35139085 (Publication Type: Journal Article)

Topics

• Adult
• Cardiometabolic Risk Factors
• Cardiovascular Diseases (diagnosis, epidemiology, etiology)
• Diabetes, Gestational (diagnosis, epidemiology)
• Female
• Follow-Up Studies
• Humans
• Hyperglycemia (complications, diagnosis, epidemiology)
• Metabolic Syndrome (diagnosis, epidemiology, etiology)
• Pregnancy
• Pregnancy Complications (diagnosis, epidemiology)
• Prenatal Diagnosis (statistics & numerical data)
• Prevalence
• Prognosis
• South Africa (epidemiology)
• Time Factors
• Urban Population (statistics & numerical data)