Dr. Anita Kant
Women with a history of gestational diabetes mellitus (GDM) are nearly twice more likely to develop chronic kidney disease (CKD) later on in life, irrespective of whether they develop diabetes and/or hypertension, according to a recent study from Denmark published in the journal Diabetes Care.1
A group of researchers from the Odense University Hospital and University of Southern Denmark in Odense, Denmark conducted this study to investigate if GDM was related to the development of kidney disease. The study also examined the potential mediating effects of diabetes and hypertension on this association. Furthermore, the impact of the severity of metabolic dysfunction during pregnancy on the risk of developing kidney disease was also assessed.
This cohort study sourced data from the Danish national registry and included 697,622 women who delivered between 1997 and 2018. Researchers used ICD 10 diagnosis codes to identify cases of acute kidney disease and CKD. The severity of metabolic dysfunction during pregnancy was assessed using a proxy measure based on GDM diagnosis and insulin treatment, and this measure was included in the models as an interaction term. Mediation analyses were conducted to quantify the mediating effects of subsequent diabetes and hypertension on the development of kidney disease.
Data from 697,622 women was analysed with a median follow-up period of ~12 years. Of these, 3.4% had a history of GDM and 12.8% of those with GDM had received insulin due to severe metabolic dysfunction.
The findings indicate that the risk of CKD was significantly higher in women with GDM with an adjusted hazard ratio (aHR) of 1.92. However, GDM had no impact on the risk for acute kidney disease (aHR 1.08). Further analysis using mediation techniques revealed that a significant proportion of the association between GDM and CKD can be attributed to indirect effects of diabetes and hypertension. Approximately 75.7% of the association was mediated by diabetes, while 30.3% was mediated by hypertension. Additionally, the study found that women with insulin-treated GDM and no subsequent diabetes had a significantly increased risk of CKD compared to women without GDM, with an aHR of 2.35. This suggests that insulin-treated GDM may be an important factor in predicting CKD risk, even in the absence of subsequent diabetes.
To conclude, this study sheds light on the relationship between GDM and kidney disease. It indicates that there is a notable increase in the risk of CKD following GDM, regardless of whether the women later developed diabetes or hypertension. Those who developed diabetes and hypertension after GDM were at an even greater risk. “The significantly elevated CKD risk was observed from 2 years after pregnancy and beyond”, write the authors. Those who experienced severe metabolic dysfunction during pregnancy, necessitating insulin therapy, had the highest risk of developing CKD.
These findings highlight the importance of monitoring and managing the long-term health implications for women with a history of GDM, particularly those with significant metabolic dysfunction during pregnancy.
Reference
1. Christensen MH, et al. Kidney disease in women with previous gestational diabetes mellitus: a nationwide register-based cohort study. Diabetes Care. 2023 Dec 15:dc231092. doi: 10.2337/dc23-1092.
Dr. Anita Kant is Chairman & Head Department of Gynae & Obstetrics, Asian Institute of Medical Sciences, Faridabad
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