Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting

Abstract

Background
Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in
women with prior HFDP versus women without HFDP 3–6 years post-partum in urban
South Africa.

Design and methods
A prospective cohort study was performed of 103 black African women with prior HFDP and
101 without HFDP, 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital,
Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants
were re-evaluated for anthropometric measurements, body composition utilizing dual energy
X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin,
lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker
for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models.

Results
Forty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP
group(p<0.001); only 20(43.4%) were aware of their diabetic status in the whole group. The dds(OR, 95% confidence interval(CI)) of progressing to type 2 diabetes(T2DM) and metabolic syndrome(MetS) after correcting for confounders in the HFDP group was 10.5(95% CI
3.7–29.5) and 6.3(95%CI 2.2–18.1), respectively. All visceral fat indices were found to be
significantly higher in the HFDP group after adjusting for baseline body mass index. Tenyear estimated cardiovascular risk(FRS) and mean cIMT was statistically higher in the
HFDP group(8.46 IQR 4.9–14.4; 0.48 mm IQR 0.44–0.53 respectively) compared to the
non-HFDP group(3.48 IQR 2.1–5.7; 0.46mm IQR 0.42–0.50) respectively and this remained
significant for FRS but was attenuated for cIMT after correcting for confounders. HIV did not
play a role in progression to any of these outcomes.

Conclusion
Women with a history of HFDP have a higher risk of cardiometabolic conditions within 6
years post-partum in an urban sub-Saharan African setting.

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Identifiers

ORCID for S. A. Norris: orcid.org/0000-0001-7124-3788

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