Cardiometabolic Outcomes of Women Exposed to Hyperglycaemia First Detected in Pregnancy at 3–6 Years Post-Partum in an Urban South African Setting

Objective: Comparison of cardiometabolic outcomes in women exposed to hyperglycaemia first detected in pregnancy (HFDP) and a control group 3–6 years post-partum in urban South Africa. Design and Methods: A comparative study was performed of 103 women exposed to HFDP and 101 not exposed to HFDP 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data were obtained from medical records. Post-partum, participants were re-evaluated for biochemical analysis (two-hour 75gm OGTT, fasting insulin, lipids creatinine and glucose levels). Cardiovascular risk was assessed by estimation of the Framingham risk score (FRS). Carotid intima media thickness (CIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to these cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. Results: 46 (45.1%) HFDP-exposed women progressed to diabetes compared to 5 (5.0%) women in the control group (p<0.001); only 20 (43.4%) of the HFDP group were aware of their diabetic status. Adjusted odds ratio (aOR, 95% confidence interval (CI)) of progressing to type 2 diabetes was 11.0 (3.3–36.2). Both 10-year estimated cardiovascular risk (FRS) and mean CIMT were statistically higher in the HFDP-exposed group (8.46 IQR 4.9–14.4; 0.48 mm IQR 0.44-0,53, respectively) compared to the control group (3.48 IQR 2.1–5.7; 0.46mm IQR 0.42–0.50 respectively) though mostly driven by age, systolic blood pressure and diabetes. Conclusion: African women with a history of HFDP have an increased risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.