The following is a summary of “Adverse pregnancy outcomes and risk of type 2 diabetes in postmenopausal women,” published in the January 2024 issue of Obstetrics and Gynecology by Zhu, et al.

While the link between gestational diabetes mellitus (GDM) and delivering high-birthweight infants and the subsequent risk of type 2 diabetes mellitus (T2DM) is well-established, the relationship between hypertensive disorders of pregnancy and other adverse pregnancy outcomes with T2DM remained unclear. For a study, researchers sought to investigate the connections between various adverse pregnancy outcomes and incident T2DM among postmenopausal women.

The study utilized data from the Women’s Health Initiative, a nationwide cohort of postmenopausal women. Participants reported their history of adverse pregnancy outcomes, including GDM, hypertensive disorders of pregnancy, preterm birth, and delivering low-birthweight (<2500 g) or high-birthweight (>4500 g) infants. Follow-ups occurred annually from baseline (1993–1998) to March 2021, tracking self-reported incidents of T2DM treated with medication. Logistic regression was employed to analyze the associations between any and individual adverse pregnancy outcomes and T2DM. Additionally, stratified analyses were conducted to evaluate potential effect modification by factors such as body mass index, race and ethnicity, education, parity, breastfeeding, and age at first birth.

The analysis involved 49,717 women who were initially free of diabetes mellitus and had at least one pregnancy, all of whom responded to the questionnaire regarding adverse pregnancy outcomes. After accounting for body mass index, demographic factors, lifestyle habits, and reproductive history, it was found that gestational diabetes mellitus (odds ratio [OR]: 2.26; 95% CI: 1.94–2.63), high birthweight (OR: 1.30; 95% CI: 1.18–1.44), and hypertensive disorders of pregnancy (OR: 1.18; 95% CI: 1.08–1.30) were each independently associated with an increased likelihood of developing type 2 diabetes mellitus. Conversely, preterm birth and low birth weight did not demonstrate significant associations with the risk of diabetes mellitus. Notably, a history of two or more adverse pregnancy outcomes was linked to higher odds of developing type 2 diabetes mellitus (OR: 1.55; 95% CI: 1.28–1.88). Moreover, women with a history of both gestational diabetes mellitus and hypertensive disorders of pregnancy exhibited substantially elevated odds of type 2 diabetes mellitus (OR: 3.69; 95% CI: 2.38–5.70) compared to those without any adverse pregnancy outcomes.

Postmenopausal women who have experienced gestational diabetes mellitus delivered high-birthweight infants or suffered from hypertensive disorders during pregnancy face an increased risk of developing type 2 diabetes mellitus later in life. Furthermore, individuals with a history of multiple adverse pregnancy outcomes are at heightened risk and may benefit from prioritized screening and preventive measures for type 2 diabetes mellitus.

Reference: ajog.org/article/S0002-9378(23)00502-1/abstract