Solely Focusing on Either Gestational Diabetes or Hypertension Loses Sight of Future Health Implications

This article is brought to you by a diabetes prevention partnership of the Oregon Medical Association and American Medical Association.

February 11, 2019 

It’s well known that women who have gestational diabetes are likely to develop type 2 diabetes later, and women who have gestational hypertension will likely develop high blood pressure later. But the two are not mutually exclusive.

Recent research published in the American Journal of Epidemiology reveals that considering both conditions separately during pregnancy underestimates some key indicators for future disease.

Study results revealed that pregnant patients who have both gestational diabetes and gestational hypertension are at a greater risk of developing type 2 diabetes, hypertension and cardiovascular disease after pregnancy.

This underscores the need to identify patients at greater risk for these conditions, the importance around type 2 diabetes prevention efforts and hypertension management, and controlling the high rates of incidence associated with both types of disease.

Uncovering the Link between Diabetes and Hypertension

The study examined more than 63,000 women, between 1990 and 2007, who were mothers matched in pairs. The matched pairs were made up of women diagnosed with gestational diabetes alongside mothers who did not develop gestational diabetes.

Researchers discovered the following:

Having one condition during pregnancy increased the likelihood of cardiometabolic disease, but having both conditions significantly increased the risk further.

  • The subsequent type 2 diabetes risk for pregnant women who had either gestational diabetes or hypertension was 15 times higher compared to those without gestational diabetes or hypertension. But for women who had both conditions, the risk was 37 times higher.
  • Risk for subsequent hypertension doubled for pregnant women with either gestational condition, however, for women with both gestational diabetes and gestational hypertension, the risk was nearly six times higher.

With both gestational diabetes and gestational hypertension present, time to subsequent cardiometabolic diagnosis was shorter.

  • A type 2 diabetes diagnosis came at 4.6 years for women with both conditions vs. 5.3 years for women with one condition.
  • Time to diagnosis for hypertension came at 6 years for women with both conditions vs. 9.3 years for women with one condition.
  • The time to cardiovascular disease was 10.8 years for women with both conditions vs. 11.4 years for those with a history of either condition.

The study also followed up with the fathers and found that they had increased risks for these conditions as well.

Developing a Big-Picture Strategy

After birth, gestational diabetes and hypertension resolve, and since moms are more focused on the health of their babies, they tend to put their own health on the back burner, researchers observed.

These conditions are more likely to return after pregnancy when weight gain comes into play. But this gives you an opportunity to partner with patients—both moms and dads—when you notice the scales beginning to tip. 

Women with a history of gestational diabetes who are overweight or obese are eligible to participate in an intensive lifestyle change program that is part of the National Diabetes Prevention Program where participation can reduce their risk of developing type 2 diabetes by 58 percent.

The American Medical Association teamed up with the Centers for Disease Control and Prevention (CDC) to develop resources you can use to educate and manage your patient population and prevent chronic disease.

Strategies you can use to help your patients include:

What’s at Stake?

According to the CDC, the prevalence of gestational diabetes is estimated to be 9.2 percent with 2 to 10 percent of U.S. pregnancies being affected by it.

The CDC also reports that 50 percent of women with gestational diabetes go on to have type 2 diabetes. And babies of these moms have a greater risk of obesity as children or teens and are more likely to develop type 2 diabetes later on in life.

In the last 20 years, diabetes diagnoses have more than tripled in U.S. adults thanks to an aging and overweight population.

Nearly 85 million U.S. adults have high blood pressure, and 45.9 percent of adults with hypertension don’t have it under control.

These stats reveal how diabetes, hypertension and obesity continue to increase over time. This highlights the importance of strategies that prevent and offer treatment to reduce diabetes, hypertension and cardiovascular disease, which has become a national health crisis. Using key tools to partner with your patients in screening and management of these chronic conditions can have a substantial impact on improving population health.

 

v2 2016