Women with a history of gestational diabetes are also at risk for cardiovascular complications associated with dyslipidemia, hypertension, and abdominal obesity-the metabolic syndrome (Chap. 48, p. 937). In a study of 47,909 parous women, Kessous and coworkers (2013) evaluated subsequent hospitalizations due to cardiovascular morbidity. hey found that almost 5000 women with gestational diabetes were 2.6 times more likely to be hospitalized for cardiovascular morbidity. Another study evaluated 483 women between 5 and 10 years ater being diagnosed with mild gestational diabetes (Varner, 2017). Investigators found no increased risk for developing metabolic syndrome associated with additional pregnancies. However, risk for subsequent diabetes rose almost fourfold if gestational diabetes complicated at least one subsequent pregnancy.
In a metaanalysis of published reports from 1973 through 2014, the pooled gestational diabetes recurrence rate was 48 percent (Schwartz, 2015). Rates in primiparas were lower (40 percent) than in multiparas (73 percent). The same group of investigators identified maternal BMI, insulin use, fetal macrosomia, and weight gain between pregnancies as additional risk factors for gestational diabetes recurrence (Schwartz, 2016). Thus, lifestyle behavioral changes that include weight control and exercise between pregnancies would seem likely to prevent gestational diabetes recurrence. Gueli and colleagues (2016) were unable to demonstrate a lower recurrence rate in women randomized to an exercise program that started before 14 weeks' gestation in a subsequent pregnancy. Conversely, Ehrlich and colleagues (2011) found that prepregnancy loss of at least two BMI units was associated with a lower subsequent risk of gestational diabetes in women who were overweight or obese in the irst pregnancy.
Adane A, Mishra GO, Tooth LR: Diabetes in pregnancy and childhood cognitive development: a systematic review. Pediatrics 137(5):pii:e20154234, 2016 lberico S, Erenbourg A, Hod M, et al: Immediate delivery or expectant management in GDM at term: the GINEXMAL randomised controlled trial. B]OG 124(4):669,t201y
Alvarez ]R, Fechner A], Williams SF, et al: Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus. Am ] Perinat 27(3):231,t2010
Ambia M, Seacely AR, Macias 0, et al: The impact of baseline proteinuria in pregnancy in a contemporary diabetic population. Presented at the 38th Annual Meeting of the Society for Maternal-Fetal Medicine, January 29-February 3,t2018
American Academy of Ophthalmology: Diabetic Retinopathy PPP-Updated 20 16 . Available at: h ttps: / /www.aao. 0rg/ preferred -p ractice-pattern/ diabeticretinopathy-ppp-updated-2016. Accessed November 5, 2017
American College of Obstetricians and Gynecologists: Management of diabetes mellitus in pregnancy. Technical Bulletin No. 92, May 1986
American College of Obstetricians and Gynecologists: Fetal macrosomia. Practice Bulletin No. 173, November 2016a
American College of Obstetricians and Gynecologists: Pregestational diabetes mellitus. Practice Bulletin No. 60, 2005, Reairmed 2016b