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BMC Cardiovascular Disorders

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Open Access 01-12-2014 | Research article

Association of Gestational Diabetes Mellitus (GDM) with subclinical atherosclerosis: a systemic review and meta-analysis

Authors: Jing-Wei Li, Si-Yi He, Peng Liu, Lin Luo, Liang Zhao, Ying-Bin Xiao

Published in: BMC Cardiovascular Disorders | Issue 1/2014

Abstract

Background

Gestational diabetes mellitus (GDM) is associated with an elevated risk of adverse health outcomes such as type 2 diabetes and cardiovascular diseases. Carotid intima-media thickness (cIMT) is increasingly used as a noninvasive marker for subclinical atherosclerosis. Whether there is a direct correlation between GDM and elevated cIMT is still controversial.

Methods

PubMed, Embase and reference lists of relevant papers were reviewed. Studies assessing the relationship between GDM and cIMT were included. Weighted Mean Difference (WMD) of cIMT was calculated using random-effect models.

Results

Fifteen studies with a total of 2247 subjects were included in our analysis, giving a pooled WMD of 0.05 (95% confidence interval [CI] 0.03 –0.07). Furthermore, meta regression and subgroup analysis found that the association between GDM and larger cIMT already existed during pregnancy, and this relation was stronger in obese GDM patients.

Conclusions

GDM in and after pregnancy is associated with subclinical atherosclerosis. Weight control may be helpful to prevent cardiovascular diseases for GDM patients.

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Akinci B, Celtik A, Genc S, Yener S, Demir T, Secil M, Kebapcilar L, Yesil S: Evaluation of postpartum carbohydrate intolerance and cardiovascular risk factors in women with gestational diabetes. Gynecol Endocrinol. 2011, 27 (5): 361-367. 10.3109/09513590.2010.492885.CrossRefPubMed

Harreiter J, Dovjak G, Kautzky-Willer A: Gestational diabetes mellitus and cardiovascular risk after pregnancy. Womens Health. 2014, 10 (1): 91-108.

Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksass A: Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Wkly. 2012, 142: w13705-PubMed

Touboul PJ, Vicaut E, Labreuche J, Acevedo M, Torres V, Ramirez-Martinez J, Vinueza R, Silva H, Champagne B, Hernandez-Hernandez R, Wilson E, Schargrodsky H, CS Investigators: Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results. Cerebrovasc Dis. 2011, 31 (1): 43-50. 10.1159/000320264.CrossRefPubMed

Polak JF, Pencina MJ, Pencina KM, O’Donnell CJ, Wolf PA, D’Agostino RB: Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med. 2011, 365 (3): 213-221. 10.1056/NEJMoa1012592.CrossRefPubMedPubMedCentral

Zhang Y, Guallar E, Qiao Y, Wasserman BA: Is Carotid Intima-Media Thickness as Predictive as Other Noninvasive Techniques for the Detection of Coronary Artery Disease?. Arterioscler Thromb Vasc Biol. 2014, 37 (7): 1341-5. doi:10.1161/ATVBAHA.113.302075. Epub 2014 Apr 24CrossRef

Rademaker AA, Danad I, Groothuis JG, Heymans MW, Marcu CB, Knaapen P, Appelman YE: Comparison of different cardiac risk scores for coronary artery disease in symptomatic women: do female-specific risk factors matter?. Eur J Prev Cardiol. 2013, [Epub ahead of print]

Akinci B, Celtik A, Yener S, Genc S, Tunali S, Yuksel F, Ozcan MA, Secil M, Yesil S: Plasma thrombin-activatable fibrinolysis inhibitor levels are not associated with glucose intolerance and subclinical atherosclerosis in women with previous gestational diabetes. Clin Appl Thromb Hemost. 2011, 17 (6): E224-E230. 10.1177/1076029610397753.CrossRefPubMed

Akinci B, Celtik A, Yuksel F, Genc S, Yener S, Secil M, Ozcan MA, Yesil S: Increased osteoprotegerin levels in women with previous gestational diabetes developing metabolic syndrome. Diabetes Res Clin Pract. 2011, 91 (1): 26-31. 10.1016/j.diabres.2010.09.028.CrossRefPubMed

10.

Akinci B, Demir T, Celtik A, Baris M, Yener S, Ozcan MA, Yuksel F, Secil M, Yesil S: Serum osteoprotegerin is associated with carotid intima media thickness in women with previous gestational diabetes. Diabetes Res Clin Pract. 2008, 82 (2): 172-178. 10.1016/j.diabres.2008.07.014.CrossRefPubMed

11.

Akinci B, Celtik A, Tunali S, Genc S, Yuksel F, Secil M, Ozcan MA, Bayraktar F: Circulating apelin levels are associated with cardiometabolic risk factors in women with previous gestational diabetes. Arch Gynecol Obstet. 2014, 289 (4): 787-793. 10.1007/s00404-013-3070-y.CrossRefPubMed

12.

Vural M, Camuzcuoglu H, Toy H, Cece H, Aydin H, Eren MA, Kocyigit A, Aksoy N: Evaluation of the future atherosclerotic heart disease with oxidative stress and carotid artery intima media thickness in gestational diabetes mellitus. Endocr Res. 2012, 37 (3): 145-153. 10.3109/07435800.2012.654556.CrossRefPubMed

13.

Eren MA, Vural M, Cece H, Camuzcuoglu H, Yildiz S, Toy H, Aksoy N: Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes. Gynecol Endocrinol. 2012, 28 (12): 1010-1013. 10.3109/09513590.2012.705371.CrossRefPubMed

14.

Atay AE, Simsek H, Demir B, Sakar MN, Kaya M, Pasa S, Demir S, Sit D: Noninvasive assessment of subclinical atherosclerosis in normotensive gravidae with gestational diabetes. Herz. 2014, 39 (5): 627-632. 10.1007/s00059-013-3874-3. Epub 2013 Jul 18CrossRefPubMed

15.

Bo S, Valpreda S, Menato G, Bardelli C, Botto C, Gambino R, Rabbia C, Durazzo M, Cassader M, Massobrio M, Pagano G: Should we consider gestational diabetes a vascular risk factor?. Atherosclerosis. 2007, 194 (2): e72-e79. 10.1016/j.atherosclerosis.2006.09.017.CrossRefPubMed

16.

Caliskan M, Caklili OT, Caliskan Z, Duran C, Ciftci FC, Avci E, Gullu H, Kulaksizoglu M, Koca H, Muderrisoglu H: Does Gestational Diabetes History Increase Epicardial Fat and Carotid Intima Media Thickness?. Echocardiography. 2014, doi:10.1111/echo.12597. [Epub ahead of print]

17.

Fakhrzadeh H, Alatab S, Sharifi F, Mirarefein M, Badamchizadeh Z, Ghaderpanahi M, Hashemi Taheri AP, Larijani B: Carotid intima media thickness, brachial flow mediated dilation and previous history of gestational diabetes mellitus. J Obstet Gynaecol Res. 2012, 38 (8): 1057-1063. 10.1111/j.1447-0756.2011.01829.x.CrossRefPubMed

18.

Freire CM, Barbosa FB, De Almeida MC, Miranda PA, Barbosa MM, Nogueira AI, Guimaraes MM, Nunes Mdo C, Ribeiro-Oliveira A: Previous gestational diabetes is independently associated with increased carotid intima-media thickness, similarly to metabolic syndrome - a case control study. Cardiovasc Diabetol. 2012, 11: 59-10.1186/1475-2840-11-59.CrossRefPubMedPubMedCentral

19.

Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, Lewis CE: History of Gestational Diabetes Mellitus and Future Risk of Atherosclerosis in Mid-life: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc. 2014, 3 (2): e000490-10.1161/JAHA.113.000490.CrossRefPubMedPubMedCentral

20.

Ijas H, Morin-Papunen L, Keranen AK, Bloigu R, Ruokonen A, Puukka K, Ebeling T, Raudaskoski T, Vaarasmaki M: Pre-pregnancy overweight overtakes gestational diabetes as a risk factor for subsequent metabolic syndrome. Eur J Endocrinol. 2013, 169 (5): 605-611. 10.1530/EJE-13-0412.CrossRefPubMed

21.

Ku YH, Choi SH, Lim S, Cho YM, Park YJ, Park KS, Kim SY, Jang HC: Carotid intimal-medial thickness is not increased in women with previous gestational diabetes mellitus. Diab Metab J. 2011, 35 (5): 497-503. 10.4093/dmj.2011.35.5.497.CrossRef

22.

Ozuguz U, Isik S, Berker D, Arduc A, Tutuncu Y, Akbaba G, Gokay F, Guler S: Gestational diabetes and subclinical inflammation: evaluation of first year postpartum outcomes. Diabetes Res Clin Pract. 2011, 94 (3): 426-433. 10.1016/j.diabres.2011.08.024.CrossRefPubMed

23.

Tarim E, Yigit F, Kilicdag E, Bagis T, Demircan S, Simsek E, Haydardedeoglu B, Yanik F: Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus. Ultrasound Obstet Gynecol. 2006, 27 (2): 177-182. 10.1002/uog.2687.CrossRefPubMed

24.

Vastagh I, Horvath T, Garamvolgyi Z, Rosta K, Folyovich A, Rigo J, Kollai M, Bereczki D, Somogyi A: Preserved structural and functional characteristics of common carotid artery in properly treated normoglycemic women with gestational diabetes mellitus. Acta Physiol Hung. 2011, 98 (3): 294-304. 10.1556/APhysiol.98.2011.3.6.CrossRefPubMed

25.

Volpe L, Cuccuru I, Lencioni C, Napoli V, Ghio A, Fotino C, Bertolotto A, Penno G, Benzi L, Del Prato S, Di Cianni G: Early subclinical atherosclerosis in women with previous gestational diabetes mellitus. Diabetes Care. 2008, 31: e32-10.2337/dc08-0047.CrossRefPubMed

26.

Yousefzadeh G, Hojat H, Enhesari A, Shokoohi M, Eftekhari N, Sheikhvatan M: Increased carotid artery intima-media thickness in pregnant women with gestational diabetes mellitus. J Tehran Heart Cent. 2012, 7 (4): 156-159.PubMedPubMedCentral

27.

Sullivan SD, Umans JG, Ratner R: Gestational diabetes: Implications for cardiovascular health. Curr Diab Rep. 2012, 12 (1): 43-52. 10.1007/s11892-011-0238-3.CrossRefPubMed

28.

Sugiyama T, Nagao K, Metoki H, Nishigori H, Saito M, Tokunaga H, Nagase S, Sugawara J, Watanabe Y, Yaegashi N, Sagawa N, Sanaka M, Akazawa S, Anazawa S, Waguri M, Sameshima H, Hiramatsu Y, Toyoda N: Pregnancy outcomes of gestational diabetes mellitus according to pre-gestational BMI in a retrospective multi-institutional study in Japan. Endocr J. 2014, 61: 373-380. 10.1507/endocrj.EJ13-0541.CrossRefPubMed

29.

Fadl H, Magnuson A, Ostlund I, Montgomery S, Hanson U, Schwarcz E: Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case–control study. BJOG. 2014, doi:10.1111/1471-0528.12754. [Epub ahead of print]

30.

Berggren EK, Boggess KA, Stuebe AM, Jonsson Funk M: National Diabetes Data Group vs Carpenter-Coustan criteria to diagnose gestational diabetes. Am J Obstet Gynecol. 2011, 205 (3): 253 e251-257.CrossRef

31.

Simmons D, McElduff A, McIntyre HD, Elrishi M: Gestational diabetes mellitus: NICE for the U.S.? A comparison of the American Diabetes Association and the American College of Obstetricians and Gynecologists guidelines with the U.K. National Institute for Health and Clinical Excellence guidelines. Diabetes Care. 2010, 33 (1): 34-37. 10.2337/dc09-1376.CrossRefPubMed

32.

Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC, Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK: Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011, 57: 1404-1423. 10.1016/j.jacc.2011.02.005.CrossRefPubMedPubMedCentral

33.

Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, G American College of Cardiology Foundation/American Heart Asscoiation Task Force on Practice: 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010, 122: 2748-2764.CrossRefPubMed

34.

Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997, 146 (6): 483-494. 10.1093/oxfordjournals.aje.a009302.CrossRefPubMed

35.

Hunt KJ, Williams K, Rivera D, O’Leary DH, Haffner SM, Stern MP, Gonzalez Villalpando C: Elevated carotid artery intima-media thickness levels in individuals who subsequently develop type 2 diabetes. Arterioscler Thromb Vasc Biol. 2003, 23 (10): 1845-1850. 10.1161/01.ATV.0000093471.58663.ED.CrossRefPubMed

36.

Harville EW, Viikari JSA, Raitakari OT, Juonala M: Pregnancy complications and ultrasound measures of cardiovascular risk. Am J Epidemiol. 2012, 175: S136-

37.

D’Ascenzo F, Agostoni P, Abbate A, Castagno D, Lipinski MJ, Vetrovec GW, Frati G, Presutti DG, Quadri G, Moretti C, Gaita F, Zoccai GB: Atherosclerotic coronary plaque regression and the risk of adverse cardiovascular events: a meta-regression of randomized clinical trials. Atherosclerosis. 2013, 226: 178-185. 10.1016/j.atherosclerosis.2012.10.065.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/132/prepub

Title: Association of Gestational Diabetes Mellitus (GDM) with subclinical atherosclerosis: a systemic review and meta-analysis
Authors: Jing-Wei Li
Si-Yi He
Peng Liu
Lin Luo
Liang Zhao
Ying-Bin Xiao
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-14-132

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