Pre-eclampsia and gestational diabetes mellitus are associated
with an increased risk of cardiovascular disease
Dear Dr Papageorghiou,
We read with great interest the article published in BJOG by Hildén et
al.1, in which the authors aimed to investigate if the
pre-eclampsia association with cardiovascular disease (CVD) was
independent of gestational diabetes mellitus (GDM). They indicated that
pre-eclampsia and GDM were independent risk factors for CVD, and after
stratifying by maternal body mass index (BMI), the adjusted association
of pre-eclampsia with CVD did not differ notably between BMI groups.
They concluded that pre-eclampsia and GDM were independent risk factors
for later CVD and having both during pregnancy was a major risk factor
for later CVD. Furthermore, they indicated that the association between
pre-eclampsia and CVD was not modified by BMI.
We support the information provided by Hildén et al.1,
and hypertension is a mediator of CVD rather than a component of the
diagnostic bundle. It has been shown that pre-eclampsia and GDM can
affect blood vessels, but it is not clear aetiology2.
Previous studies indicated that women with GDM have an increased risk of
developing preeclampsia, which in turn increases the risk of developing
advanced CVD3,4. However, in these studies, there were
many potential confounding factors due to the lack of adjustment for
BMI. The current research just filled in this disadvantage. We thank
Hildén et al.1 for their comprehensive contribution.
We believe that the biggest advantage of this study is that it is a
nationwide study, and the data collected prospectively has high
credibility. The main disadvantage is that women with diabetes before
pregnancy are excluded, which may have a great impact on the research
results, leading to bias. This nested case-control study included 2639
cases and 13310 controls with complete data. So large number of study
population will provide valuable guidance for clinicians to improve
their understanding of pre-eclampsia and GDM related CVD, despite some
limitations of this study. In addition, we are also looking forward to
Hildén et al.1 developing effective CVD prevention
plans for high-risk women to improve their long-term health. Therefore,
we believe the research by Muraca et al.1 will greatly promote further
researches on the pre-eclampsia and GDM related CVD.