Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study

Pregnant women commonly receive screen-
ing for gestational diabetes mellitus by use of a 50 g glu-
cose challenge test, followed by a diagnostic oral glucose
tolerance test for those whose glucose challenge test
result is abnormal. Although women with gestational
diabetes have an increased risk of cardiovascular disease,
it is not known whether mild glucose intolerance during
pregnancy is also associated with cardiovascular disease.
Thus, we sought to determine whether pregnant women
with an abnormal glucose challenge test result but with-
out gestational diabetes have an increased risk of cardio-
vascular disease.
Methods: We conducted a retrospective population-based
cohort study that included all women in Ontario aged
20–49 years with live deliveries between April 1994 and
March 1998. We excluded women with pregestational dia-
betes. The population was stratified into 3 cohorts:
women with gestational diabetes (n = 13 888); women
who received an antepartum oral glucose tolerance test
(suggestive of an abnormal result of the glucose chal lenge
test) but who did not have gestational diabetes
(n = 71 831); and women who did not receive an oral glu-
cose tolerance test (suggestive of a normal result of the
glucose challenge test) (n = 349 977). The primary outcome
was cardiovascular disease (admission to hospital for acute
myocardial infarction, coronary bypass, coronary angio-
plasty, stroke or carotid endarterectomy).
Results: Compared with women who did not receive an
oral glucose tolerance test, women with gestational dia-
betes and women who received an oral glucose tolerance
test but did not have gestational diabetes had a higher risk
of cardiovascular disease over 12.3 years of median follow-
up (adjusted hazard ratio
for women with gestational
diabetes 1.66, 95% confidence interval [CI] 1.30–2.13,
p < 0.001; adjusted HR for those with an oral glucose test
but not gestational diabetes 1.19, 95% CI 1.02–1.39,
p = 0.03).
Interpretation: Mild glucose intolerance in pregnancy may be
associated with an increased risk of cardiovascular disease.

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