Women who had diabetes in pregnancy can reduce their risk of going onto develop type 2 diabetes by following a healthy lifestyle, a large study has found.
The prospective cohort study of more than 4,000 US women who had gestational diabetes found those who followed five healthy lifestyle measures had a 92% lower risk of developing type 2 diabetes compared with women who did not follow any.
The five modifiable risk factors were maintaining a healthy weight, eating a high-quality diet, being regularly physically active, not smoking, and having moderate alcohol consumption.
Researchers found an inverse dose-response association, with the risk of type 2 diabetes decreasing with every additional healthy lifestyle measure adopted.
Women with one, two, three, four, and five optimal levels of modifiable factors compared with none had a 6%, 39%, 68%, 85%, and 92% lower risk, respectively.
‘The beneficial associations were consistently seen, even among overweight/obese women and among women with a greater genetic susceptibility to type 2 diabetes,’ researchers wrote in The BMJ.
Compared with the general population, women with a history of gestational diabetes face up to a 10-fold higher risk of progressing to type 2 diabetes, the study authors noted.
‘Gestational diabetes mellitus unmasks underlying cardiometabolic dysregulation or susceptibility at an early age, offering an opportunity for early intervention to prevent subsequent progression to type 2 diabetes,’ they wrote.
The research, which used 28 years of data from the Nurses Health II Study, highlighted the important public health opportunity for the prevention of type 2 diabetes in this high-risk population, they concluded.
In a meta-analysis of 15 studies involving more than eight million women, a history of gestational diabetes was linked with a 45% increased risk of overall cardiovascular and cerebrovascular diseases: 72% for cardiovascular diseases and 40% for cerebrovascular diseases.
The findings could not be solely attributed to conventional cardiovascular risk factors or subsequent diabetes, the researchers noted.
‘The results highlight the need for early intervention in women at high risk of gestational diabetes mellitus, and for continuous monitoring of women with gestational diabetes mellitus.’
It was not known exactly how gestational diabetes contributed to cardiovascular and cerebrovascular disease, but previous research suggested a brief period of exposure to potentially intense glucose intolerance would contribute to endothelial changes and subsequent endothelial dysfunction.
‘[This] would be further accelerated in the context of comorbidities such as obesity and dyslipidaemia, even without development of type 2 diabetes, and finally lead to clinically overt cardiovascular and cerebrovascular diseases,’ they wrote.