Is there an association between gestational diabetes mellitus in twin pregnancies and long-term maternal cardiovascular morbidity?

Objective
To investigate whether a diagnosis of gestational diabetes mellitus (GDM) in twin gestation poses a risk for subsequent maternal long-term cardiovascular morbidity.

Study Design
A population-based cohort study was conducted, comparing the incidence of cardiovascular morbidity within a cohort of women with and without a diagnosis of GDM who delivered twins in a tertiary medical center. Kaplan-Meier survival curve was used to estimate cumulative incidence of simple, complex (ie, angina pectoris and congestive heart failure, respectively) cardiovascular-related hospitalizations. Cox proportional hazard model was used to estimate the adjusted HRs for cardiovascular morbidity.

Results
Of 4,256 twin deliveries that met the inclusion criteria, 336 (7.9%) occurred in patients that were diagnosed with GDM. During a follow-up period of more than 10 years, patients with GDM had higher rates of simple cardiovascular events as compared to women without diagnosis of GDM (OR=2.7; 95% CI 1.01-7.33, P=0.048). However, there was no difference between the two groups in the rate of complex cardiovascular events, non-invasive or invasive cardiac diagnostic procedures. Total cardiovascular hospitalizations was comparable between the groups (Table). In a Cox proportional hazards model, which adjusted for maternal age, ethnicity, preeclampsia and fertility treatments, GDM in twin pregnancies was not found to be associated with long-term cardiovascular morbidity (adjusted HR 1.41, 95% CI 0.77-2.58).

Conclusion
GDM during twin pregnancy is associated with long-term maternal simple cardiovascular events during a follow-up period of more than a decade.

Table: Incidence of cardiovascular morbidity during the follow-up period in patients who delivered twins, with and without a history of gestational diabetes mellitus.

* adjusted for maternal age and ethnicity