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- Title
Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy.
- Authors
Rawal, Shristi; Olsen, Sjurdur F.; Grunnet, Louise G.; Ma, Ronald C.; Hinkle, Stefanie N.; Granström, Charlotta; Jing Wu; Yeung, Edwina; Mills, James L.; Yeyi Zhu; Wei Bao; Ley, Sylvia H.; Hu, Frank B.; Damm, Peter; Vaag, Allan; Tsai, Michael Y.; Cuilin Zhang; Wu, Jing; Zhu, Yeyi; Bao, Wei
- Abstract
<bold>Objective: </bold>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.<bold>Research Design and Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
DENMARK; GESTATIONAL diabetes; PREGNANCY; WOMEN'S health; GLOMERULAR filtration rate; HYPERTENSION in pregnancy; DIAGNOSIS; HYPERTENSION epidemiology; CHRONIC kidney failure; CREATININE; HYPERTENSION; KIDNEY function tests; KIDNEYS; KIDNEY diseases; LONGITUDINAL method; PUERPERIUM; RESEARCH funding
- Publication
Diabetes Care, 2018, Vol 41, Issue 7, p1378
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc17-2629