Gestational Diabetes Confers Cardiovascular Risk in Young Women
Cardiovascular (CV) nurses have long provided prevention-focused care for individuals, families, and communities across the life course. Moving forward, CV nurses will increasingly become leaders in the care of pregnant and postpartum women during and after gestational diabetes mellitus (GDM), glucose intolerance that is identified first during pregnancy, and is determined to not be pre-existing type 2 diabetes (T2D). GDM median prevalence approximates 8.9% in North America and 5.8% to 12.9% worldwide1, and women diagnosed with GDM have ten times the risk of developing T2D2 and a 2.3-fold increased risk of cardiovascular events in the first decade postpartum3 compared to women without GDM.
Women who are diagnosed with GDM have a twofold higher risk of cardiovascular events postpartum compared with their peers. A recent systematic review and meta-analysis, with a pooled sample of over 5.3 million women, showed that CV risk becomes apparent within the first decade after pregnancy and is not dependent upon the development of T2D.3 These women are an at-risk population and need CVD risk factor screening as well as glucose screening.3
The postpartum period (generally defined as the first year following birth) represents a window of opportunity to implement guideline-based screening and initiate interventions to promote postpartum weight loss and improve cardiometabolic health. Yet, women with a history of GDM frequently receive low rates of counseling regarding their future risk and low rates of referrals to primary care providers for prevention-focused testing, monitoring, and education.4 For example, a recent systematic review revealed that the screening rate for T2D in women with prior GDM did not exceed 58% by 4-months postpartum across the eight observational studies analyzed.5 Current postpartum glucose screening rates for at-risk U.S. women are suboptimal and vary substantially.5 In the United States, Black, Latina and Native American women are least likely to be tested and followed despite their well-known increased cardiometabolic risk.5 Individualized interventions that address recent motherhood, culture, socio-economic status, and the complex realities in women’s daily lives have shown promise in improving postpartum weight loss and dietary behaviors.6 However, these have largely not been translated or made accessible to women in geographically and socioeconomically diverse communities and communities of color who are the most likely to develop T2D and CVD.
CV nurses are well-positioned to help change the landscape of women’s health care at the intersection of women’s obstetrical health and their CV health. Almost a decade ago, in 2011, the American Heart Association and American College of Cardiology issued a joint practice guideline for CVD prevention in women that emphasized the need for postpartum follow-up care after GDM, hypertensive disorders of pregnancy, and preterm labor.7 Follow-up care after GDM focused primarily on glucose screening; recent research findings point to the need to update the guidelines to address the additional need for CVD risk factor screening.3 Unfortunately, research also indicates that not much has changed since 2011 to improve the delivery of prevention-focused care for diverse, at-risk women. U.S. women continue to receive siloed care, if any, after they give birth. CV nurses are compelled to individually and collectively do their part to break down these siloes. A very good place to start is reviewing the PCNA slide set concerning the cardiometabolic risk conferred by complications of pregnancy – and then spread the word and commit to the work of optimizing CV prevention in this population.