SEATTLE (EGMN) – Women who have had gestational diabetes may be at elevated risk for hypertension even after established risk factors are taken into account, a nested cohort study indicates.
Using data from the Nurses’ Health Study II, researchers followed more than 26,000 women in the United States from an index pregnancy for up to 14 years. Those who had gestational diabetes during that pregnancy were 41% more likely to develop hypertension even after adjustment for potential confounders such as body mass index, diet, and family history of hypertension. The findings were reported at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.
“These women may represent a target group for intervention to prevent or delay the onset of hypertension, which is a public health concern in the United States,” lead investigator Deirdre K. Tobias concluded.
“The mechanism by which gestational diabetes mellitus could lead to an increased risk of hypertension and other metabolic complications is not yet established,” said Ms. Tobias, a doctoral student at the Harvard School of Public Health in Boston.
One possibility is that these conditions have shared risk factors, she noted. Another is that gestational diabetes itself increases the risk of hypertension, for example, by causing vascular damage that manifests later in time.
The Nurses’ Health Study II is a prospective cohort study of women 25-44 years old at baseline that began in 1989.
Women in the study complete extensive questionnaires at baseline and biennially, which include questions about physician-diagnosed gestational diabetes and hypertension.
Ms. Tobias and her colleagues included in their sample the 26,384 women who reported having at least one singleton pregnancy between 1991 (the first year in which dietary data were collected) and 2005, did not have type 2 diabetes or hypertension, had not experienced gestational diabetes in a previous pregnancy, and had not had previous cardiovascular disease.
Study results showed that 6% of the women had gestational diabetes during their index pregnancy. Both the women with and without gestational diabetes had a mean age of 32 years at baseline, and 7% in each group were current smokers.
However, those with gestational diabetes had a higher body mass index (25 vs. 23 kg/m2), and were more likely to have a family history of hypertension (51% vs. 46%) and diabetes (21% vs. 11%). They also were more likely to have a personal history of toxemia, preeclampsia, or hypertension during pregnancy (16% vs. 8%).
Overall, 9% of the women developed hypertension during follow-up, and the cumulative incidence was higher among those who had had gestational diabetes.
After adjustment for a dozen potential confounders, women who experienced gestational diabetes still had a 41% higher risk of developing hypertension (hazard ratio 1.41).
Moreover, compared with women who experienced neither gestational diabetes nor type 2 diabetes, those who experienced both had a near tripling of the risk of developing hypertension (HR 2.95).
“It is possible that there was residual or unmeasured confounding,” acknowledged Ms. Tobias. “For example, in our cohort, we were unable to capture pregnancy-related characteristics, such as weight gain or severity of gestational diabetes.”
In addition, she noted, the generalizability of the study’s findings may be limited, given the women’s somewhat higher age at baseline and the fact that most were white.
Ms. Tobias reported that she had no relevant conflicts of interest.
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西雅图(EGMN)——一项巢式队列研究表明，有妊娠糖尿病病史的妇女发生高血压的风险升高，即便在考虑明确的危险因素后亦如此。
利用护士健康研究II的数据，研究者们对美国索引妊娠中逾26,000位妇女随访达14年。妊娠期间患妊娠糖尿病者发生高血压的几率增加41%，即便在对体重指数、膳食和高血压家族史等潜在混杂因素进行调整后亦如此。该结果公布于美国儿科与围产期流行病学研究协会(Society for Pediatric and Perinatal Epidemiologic Research)年会上。
首席研究员Deirdre K. Tobias博士断言道：“这些妇女可以代表为预防或推迟高血压发病而采取干预措施的目标治疗组，而高血压是美国的一个公共卫生问题。”
波士顿哈佛公共卫生学院的博士生Tobias女士说：“妊娠糖尿病导致高血压及其他代谢并发症风险增加的机制尚未确定”。
一种可能为，这些疾病有共同的危险因素，她指出。另一种可能为，妊娠糖尿病本身可增加高血压风险，例如通过引起血管损伤，而这种损伤以后迟早会显现出来。
护士健康研究II是始于1989年、对基线时年龄为25~44岁的妇女所进行的一项前瞻性队列研究。
该研究中的妇女在基线时及此后每2年完成综合问卷调查，其中包括与医生诊断的妊娠糖尿病和高血压相关的问题。
Tobias女士及其同事将具有如下特征的妇女纳入样本中：报告于1991年(收集膳食数据的第一年)~2005年间至少有过一次单胎妊娠；无2型糖尿病或高血压病史；前次妊娠中未发生妊娠糖尿病；既往无心血管疾病病史。
研究结果表明，6%的妇女在其索引妊娠过程中发生妊娠糖尿病。患妊娠糖尿病的妇女与未患此病者的基线时平均年龄均为32岁，各组均有7%为当前吸烟者。
然而，妊娠糖尿病患者体重指数偏高(25对23 kg/m2)，高血压家族史 (51% 对 46%)和糖尿病病史(21% 对 11%)更为常见，这组患者妊娠期间出现毒血症、先兆子痫或高血压等个人史亦较多见。
总之，9%的妇女在随访过程中发生高血压，有妊娠糖尿病病史者中累计发病率较高。
在对诸多潜在混杂因素进行调整后，曾出现妊娠糖尿病的妇女发生高血压的风险增加41% [危险比(HR1.41)]。
而且，与无妊娠糖尿病或2型糖尿病病史的妇女相比较，有上述两种类型糖尿病病史的妇女发生高血压的风险几乎增加2倍(HR 2.95)。
“可能还会有其他的或无法测量的混杂因素，”Tobias女士坦言。“例如，在我们的队列中，我们无法获取到妊娠相关的特征，如体重增加或妊娠糖尿病的严重程度。”
另外她还指出，鉴于这些妇女在基线时年龄略微偏大及大多数为白种人这一事实，该研究结果的普遍性可能有限。
Tobias女士无相关经济利益冲突的报告。
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