Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study
Objective: An increasing trend in the prevalence of gestational diabetes mellitus (GDM) has been reported in Taiwan. GDM has been linked to various adverse maternal outcomes over a long period, including cardiovascular disease (CVD) and chronic kidney disease (CKD). However, evidence implies that th...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/8/2120 |
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| author | Shih-Ting Tseng Ming-Chang Lee Yi-Ting Tsai Mei-Chun Lu Su-Chen Yu I-Ju Tsai I-Te Lee Yuan-Horng Yan |
| author_facet | Shih-Ting Tseng Ming-Chang Lee Yi-Ting Tsai Mei-Chun Lu Su-Chen Yu I-Ju Tsai I-Te Lee Yuan-Horng Yan |
| author_sort | Shih-Ting Tseng |
| collection | DOAJ |
| description | Objective: An increasing trend in the prevalence of gestational diabetes mellitus (GDM) has been reported in Taiwan. GDM has been linked to various adverse maternal outcomes over a long period, including cardiovascular disease (CVD) and chronic kidney disease (CKD). However, evidence implies that the effects of GDM on the mid-term surrogate risk factors for these diseases are limited. Furthermore, data from nationwide cohort studies are limited. The primary aim of this study was to investigate the risk of developing type 2 diabetes mellitus (T2DM), arterial hypertension (aHTN), and hyperlipidemia (HL) through a 5-year follow-up post-delivery of women with GDM in a nationwide cohort study in Taiwan. The second objective was to investigate the risk of developing insulin resistance syndrome (IRS)-related diseases, including CVD, acute myocardial infarction (AMI), peripheral artery occlusive disease (PAOD), non-alcoholic fatty liver diseases (NAFLD), and CKD. Methods: This was a retrospective, population-based nationwide cohort study. The data source comprises a merge of the Birth Certificate Application Database (BCA) and the National Health Insurance Research Database in Taiwan. Women aged between 15 and 45 years who gave birth in Taiwan between 2004 and 2011 were included. Women who were enrolled and had a GDM diagnosis were assigned to the exposure group. Women who were enrolled without a GDM diagnosis were assigned to the comparison group. The relative risk of developing T2DM, aHTN, HL, and IRS-related diseases, including CVD, AMI, PAOD, NAFLD, and CKD, were analyzed and presented as hazard ratio (HR) through Cox regression and log-rank regression analyses. Results: A total of 1,180,477 women were identified through the BCA database between 2004 and 2011. Of those, 71,611 GDM-diagnosed women and 286,444 women without GDM were included in the final analysis. After adjusting for age, pre-existing cancer, and parity, developing T2DM, aHTN, and HL were still significantly increased in the GDM group (HR and interquartile range (IQR): 2.83 (2.59, 3.08), 1.09 (1.01, 1.06), and 1.29 (1.20, 1.38), accordingly). CVD, NAFLD, and CKD had a very low incidence and showed insignificant results. Conclusion: Our findings provide nationwide cohort data showing that GDM increased the risk of developing T2DM, aHTN, and HL 5 years after delivery within the same group. The GDM complications and risk of CVD, AMI, PAOD, NAFLD, and CKD need further investigation. |
| first_indexed | 2024-03-11T00:06:29Z |
| format | Article |
| id | doaj.art-619c013e5984401faea3343896923cc7 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-11T00:06:29Z |
| publishDate | 2023-07-01 |
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| spelling | doaj.art-619c013e5984401faea3343896923cc72023-11-19T00:19:42ZengMDPI AGBiomedicines2227-90592023-07-01118212010.3390/biomedicines11082120Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort StudyShih-Ting Tseng0Ming-Chang Lee1Yi-Ting Tsai2Mei-Chun Lu3Su-Chen Yu4I-Ju Tsai5I-Te Lee6Yuan-Horng Yan7Division of Endocrinology and Metabolism, Department of Internal Medicine, Kuang Tien General Hospital, Taichung 433, TaiwanDivision of Nephrology, Department of Internal Medicine, Dachien General Hospital, Miaoli 360, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, TaiwanDepartment of Medical Research, Kuang Tien General Hospital, Taichung 433, TaiwanDepartment of Nursing, Kuang Tien General Hospital, Taichung 433, TaiwanDepartment of Medical Research, Kuang Tien General Hospital, Taichung 433, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Kuang Tien General Hospital, Taichung 433, TaiwanObjective: An increasing trend in the prevalence of gestational diabetes mellitus (GDM) has been reported in Taiwan. GDM has been linked to various adverse maternal outcomes over a long period, including cardiovascular disease (CVD) and chronic kidney disease (CKD). However, evidence implies that the effects of GDM on the mid-term surrogate risk factors for these diseases are limited. Furthermore, data from nationwide cohort studies are limited. The primary aim of this study was to investigate the risk of developing type 2 diabetes mellitus (T2DM), arterial hypertension (aHTN), and hyperlipidemia (HL) through a 5-year follow-up post-delivery of women with GDM in a nationwide cohort study in Taiwan. The second objective was to investigate the risk of developing insulin resistance syndrome (IRS)-related diseases, including CVD, acute myocardial infarction (AMI), peripheral artery occlusive disease (PAOD), non-alcoholic fatty liver diseases (NAFLD), and CKD. Methods: This was a retrospective, population-based nationwide cohort study. The data source comprises a merge of the Birth Certificate Application Database (BCA) and the National Health Insurance Research Database in Taiwan. Women aged between 15 and 45 years who gave birth in Taiwan between 2004 and 2011 were included. Women who were enrolled and had a GDM diagnosis were assigned to the exposure group. Women who were enrolled without a GDM diagnosis were assigned to the comparison group. The relative risk of developing T2DM, aHTN, HL, and IRS-related diseases, including CVD, AMI, PAOD, NAFLD, and CKD, were analyzed and presented as hazard ratio (HR) through Cox regression and log-rank regression analyses. Results: A total of 1,180,477 women were identified through the BCA database between 2004 and 2011. Of those, 71,611 GDM-diagnosed women and 286,444 women without GDM were included in the final analysis. After adjusting for age, pre-existing cancer, and parity, developing T2DM, aHTN, and HL were still significantly increased in the GDM group (HR and interquartile range (IQR): 2.83 (2.59, 3.08), 1.09 (1.01, 1.06), and 1.29 (1.20, 1.38), accordingly). CVD, NAFLD, and CKD had a very low incidence and showed insignificant results. Conclusion: Our findings provide nationwide cohort data showing that GDM increased the risk of developing T2DM, aHTN, and HL 5 years after delivery within the same group. The GDM complications and risk of CVD, AMI, PAOD, NAFLD, and CKD need further investigation.https://www.mdpi.com/2227-9059/11/8/2120gestational diabetes mellitus (GDM)health outcomesincidencehazard ratiolong-term follow-upnational cohort study |
| spellingShingle | Shih-Ting Tseng Ming-Chang Lee Yi-Ting Tsai Mei-Chun Lu Su-Chen Yu I-Ju Tsai I-Te Lee Yuan-Horng Yan Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study Biomedicines gestational diabetes mellitus (GDM) health outcomes incidence hazard ratio long-term follow-up national cohort study |
| title | Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study |
| title_full | Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study |
| title_fullStr | Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study |
| title_full_unstemmed | Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study |
| title_short | Risks after Gestational Diabetes Mellitus in Taiwanese Women: A Nationwide Retrospective Cohort Study |
| title_sort | risks after gestational diabetes mellitus in taiwanese women a nationwide retrospective cohort study |
| topic | gestational diabetes mellitus (GDM) health outcomes incidence hazard ratio long-term follow-up national cohort study |
| url | https://www.mdpi.com/2227-9059/11/8/2120 |
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