Association Between Maternal Glucose Levels in Gestational Diabetes Screening and Subsequent Hypertension

Xinyun Christie Liang; Anamaria Savu; Deliwe Ngwezi; Sonia Butalia; Padma Kaul; Roseanne O Yeung

doi:10.1161/HYPERTENSIONAHA.123.21179

Association Between Maternal Glucose Levels in Gestational Diabetes Screening and Subsequent Hypertension

Hypertension. 2023 Sep;80(9):1921-1928. doi: 10.1161/HYPERTENSIONAHA.123.21179. Epub 2023 Jul 14.

Authors

Xinyun Christie Liang¹, Anamaria Savu², Deliwe Ngwezi¹, Sonia Butalia^{3

4}, Padma Kaul^{1

2}, Roseanne O Yeung^{1

5

6}

Affiliations

¹ Faculty of Medicine and Dentistry (X.L., D.N., P.K., R.O.Y.), University of Alberta, Canada.
² Canadian VIGOUR Center (A.S., P.K.), University of Alberta, Canada.
³ Department of Community Health Sciences (S.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
⁴ Division of Endocrinology and Metabolism, Department of Medicine (S.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
⁵ Division of Endocrinology and Metabolism (R.O.Y.), University of Alberta, Canada.
⁶ Physician Learning Program (R.O.Y.), University of Alberta, Canada.

PMID: 37449406
DOI: 10.1161/HYPERTENSIONAHA.123.21179

Abstract

Background: We assessed the association between maternal glucose levels in pregnancy and subsequent hypertension.

Methods: This population-level, retrospective cohort study examined women aged 12 to 54 years with singleton pregnancies completed at ≥29 weeks of gestation from October 1, 2008 to December 1, 2018 followed until March 31, 2019 in Alberta, Canada. Women were stratified by results in the 50-gram glucose challenge test and by 75-gram oral glucose tolerance test subtypes (normal oral glucose tolerance test, elevated fasting plasma glucose only [elevated fasting], elevated postload glucose only, or both elevated fasting and postload glucose [combined]. Time to development of hypertension was modeled using Cox proportional hazards models.

Results: Of 313 361 women, 231 008 (79.1%) underwent a glucose challenge test only while 60 909 (20.9%) underwent either an oral glucose tolerance test only or both. Nine thousand five hundred eighty (3.1%) developed hypertension, and 2824 (0.9%) developed cardiovascular disease over a median follow-up of 5.7 years. Every 1-mmol/L increase in glucose in the glucose challenge test increased the risk of subsequent hypertension by 15% (adjusted hazard ratio and 95% CI, 1.15 [1.14-1.16]). Among those who underwent the oral glucose tolerance test, the combined group conferred the highest risk of subsequent hypertension, followed by elevated fasting, then elevated postload glucose only (reference: glucose challenge test ≤7.1 mmol/L, adjusted hazard ratio [95% CI]: elevated postload glucose only, 1.83 [1.68-2.00]; elevated fasting 2.02 [1.70-2.40]; combined, 2.65 [2.33-3.01]). No significant associations between maternal glucose levels and cardiovascular disease were observed.

Conclusions: Increasing maternal glucose levels in pregnancy were associated with increasing risk of subsequent hypertension. These findings may help identify higher-risk women who should be targeted for earlier postpartum cardiovascular risk reduction.

Keywords: cardiovascular diseases; diabetes, gestational; hypertension; postpartum period; pregnancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Cardiovascular Diseases*
Diabetes, Gestational* / diagnosis
Diabetes, Gestational* / epidemiology
Female
Glucose
Humans
Hypertension* / diagnosis
Hypertension* / epidemiology
Pregnancy
Retrospective Studies

Substances

Blood Glucose
Glucose

Grants and funding

CIHR/Canada