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Invited Commentary
December 2017

Pregnancy and Subsequent Glucose Intolerance in Women of Childbearing Age: Heeding the Early Warning Signs for Primary Prevention of Cardiovascular Disease in Women

Author Affiliations
  • 1Cardiovascular and Metabolic Conditions Section, Division of Research, Kaiser Permanente Northern California, Oakland
  • 2Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, California
  • 3Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2017;177(12):1742-1744. doi:10.1001/jamainternmed.2017.4768

The increased physiologic and metabolic demands of pregnancy act as a “stress test” that may reveal underlying subclinical disease or provide insight into future chronic disease. Pregnancy complications, such as gestational diabetes (GD) and hypertensive disorders, are “early warning” signs for chronic disease in women decades before the menopausal transition. More than 50 years ago, O’Sullivan and Mahan1 developed criteria for the diagnosis of GD, glucose intolerance first recognized during pregnancy, based solely on observed higher rates of progression to diabetes in women many years postdelivery. A history of GD confers a 7-fold higher risk of type 2 diabetes mellitus and 3-fold higher cardiometabolic risk for women. In 2011, the American Heart Association added GD history to its CVD risk assessment for women based on the strong link to overt diabetes.2 Until recently, evidence was insufficient to determine whether a history of GD elevated CVD risk independent of its association with overt diabetes and metabolic disease.