Elevated blood pressure in pregnant women with gestational diabetes according to the WHO criteria: importance of overweight : Journal of Hypertension

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Elevated blood pressure in pregnant women with gestational diabetes according to the WHO criteria: importance of overweight

Birukov, Annaa,b,c; Glintborg, Dorted,e; Schulze, Matthias B.a,b,c,f; Jensen, Tina K.g,h,i; Kuxhaus, Olgaa; Andersen, Louise B.e,j; Kräker, Kristinc,k,l,m; Polemiti, Ellia,b; Jensen, Boye L.n; Jørgensen, Jan S.e,i,j; Dechend, Ralfc,j,k,l,o; Andersen, Marianne S.d,e

Author Information

aDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal

bGerman Center for Diabetes Research (DZD), Muenchen-Neuherberg

cDZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany

dDepartment of Endocrinology, Odense University Hospital

eInstitute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

fInstitute of Nutritional Science, University of Potsdam, Nuthetal, Germany

gDepartment of Environmental Medicine

hOPEN Patient data Explorative Network

iOdense Child Cohort, Hans Christian Andersen Children's Hospital

jDepartment of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark

kExperimental and Clinical Research Center, a joint cooperation between Max-Delbrueck-Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin

lCharité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin

mMax Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany

nInstitute for Molecular Medicine, University of Southern Denmark, Odense, Denmark

oHELIOS-Klinikum, Berlin, Department of Cardiology and Nephrology, Germany

Correspondence to Anna Birukov, PhD, Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, Nuthetal, Germany. Tel: +49 33200882431; e-mail: [email protected]

Abbreviations: ECLIA, electro-chemiluminescence immunoassay; FPG, fasting plasma glucose; GDM-WHO, gestational diabetes mellitus according to WHO 2013 threshold; HDP, hypertensive disorders of pregnancy; HOMA-IR, homeostatic model assessment of insulin resistance; IADPSG, International Association of Diabetes in Pregnancy Study Group; IQR, interquartile range; LGA, large for gestational age; NICE, National Institute for Health and Care Excellence; OGTT, oral glucose tolerance test; RCT, randomized controlled trial; SD, standard deviation

Received 14 September, 2021

Revised 25 April, 2022

Accepted 25 April, 2022

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

Journal of Hypertension 40(8):p 1614-1623, August 2022. | DOI: 10.1097/HJH.0000000000003196

Abstract

Objective: 

Hypertension before and during early pregnancy has been associated with an increased risk of gestational diabetes mellitus (GDM) in retrospective analyses. We aimed to investigate the prospective blood pressure trackings in a population-based cohort of pregnant women, who were stratified according to their metabolic status in early third trimester.

Methods: 

We recorded blood pressure longitudinally during pregnancy in 1230 women from the Odense Child Cohort, Denmark. Fasting glucose and insulin were measured at gestational weeks 28–30. Metabolic status was evaluated according to the WHO 2013 threshold for GDM (GDM-WHO: fasting plasma glucose ≥5.1 mmol/l), insulin and homeostatic model assessment of insulin resistance (HOMA-IR). Relationships between metabolic status in third trimester and blood pressure trajectories were evaluated with adjusted linear mixed models. Trajectory was defined as blood pressure records in pregnancy per 4 weeks interval.

Results: 

Prevalence of GDM-WHO was 40% (498/1230). GDM-WHO was associated with 1.46 (0.22–2.70) mmHg higher SBP and 1.04 (0.07–2.01) mmHg higher DBP trajectories in the overall cohort. The associations were driven by differences in the overweight group, with 3.14 (1.05–5.25) mmHg higher SBP and 1.94 (0.42–3.47) mmHg higher DBP per 4 weeks in women with GDM-WHO compared with women without GDM-WHO. GDM-WHO was not associated with blood pressure in women with normal weight. Blood pressure trajectories were elevated across quartiles of insulin resistance.

Conclusion: 

GDM-WHO is associated with higher blood pressure in pregnancy, and there appears to be a stronger effect in overweight women.

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