TOPLINE

More than 1 in 4 women with gestational diabetes mellitus (GDM) developed hypertension at 5 months postpartum, with Black or mixed ethnicity, higher weight, and elevated blood pressure (BP) at 12 weeks' gestation identified as key predictors. Women with postpartum hypertension also had significantly higher rates of dyslipidemia and elevated waist-to-height ratio at the 5-month follow-up, compared to women who remained normotensive.

METHODOLOGY

• A prospective observational study included 678 women with GDM (median age, 35.2 years) in their most recent pregnancy, excluding those with chronic hypertension, who attended a postnatal review at a median of 5.1 months postpartum in London, United Kingdom.
• Baseline characteristics were collected at 12 weeks' gestation, including maternal age, ethnicity, weight, height, BMI, and BP; data on pregnancy outcomes such as GDM diagnosis timing, treatment type, and development of gestational hypertension or pre-eclampsia were obtained from medical records.
• The primary outcome, postpartum hypertension, defined as systolic BP ≥ 130 mm Hg, diastolic BP ≥ 80 mm Hg, or receiving antihypertensive treatment, was assessed using standardized BP measurement protocols.
• Other outcome measures included obesity, dysglycemia (prediabetes or type 2 diabetes), dyslipidemia, and renal dysfunction (urine albumin-to-creatinine ratio ≥ 3 mg/mmol and estimated glomerular filtration rate < 90 mL/min/1.73 m²); waist-to-height ratio > 0.5 was also assessed as a measure of abnormal adiposity.
• Statistical analysis was performed to identify predictors of postpartum hypertension and develop a prenatal prediction model, with performance assessed using area under the curve (AUC).

TAKEAWAY

• Of 678 women with GDM, 179 (26.4%) developed postpartum hypertension at a median of 5.1 months after delivery; the overall cohort also showed substantial rates of other cardiometabolic abnormalities, including dysglycemia (51.8%), elevated waist-to-height ratio (74.0%), obesity (34.2%), dyslipidemia (27.4%), and renal dysfunction (11.5%).
• Significant predictors of postpartum hypertension at 12 weeks' gestation included Black ethnicity (adjusted odds ratio [aOR], 1.88; P = .007), mixed ethnicity (aOR, 2.75; P = .015), higher body weight (aOR ≥ 73 kg, 1.57; P = .034), higher systolic BP (aOR per 1 mm Hg, 1.04; P = .002), and higher diastolic BP (aOR per 1 mm Hg, 1.04; P = .036).
• Development of gestational hypertension or pre-eclampsia during pregnancy was associated with postpartum hypertension (aOR, 3.00; P < .001), but adding it to the prenatal prediction model — based on maternal characteristics at 12 weeks' gestation — only modestly improved performance, from an AUC of 0.723 to 0.739.
• Women with postpartum hypertension had significantly higher rates of dyslipidemia (35.8% vs 24.4%; P = .004) and elevated waist-to-height ratio > 0.5 (87.7% vs 69.1%; P < .001) compared to those without hypertension.

IN PRACTICE

"Our findings emphasize the importance of considering pre-existing maternal characteristics and early pregnancy maternal phenotype in cardio-renal-metabolic risk prediction following GDM, as well as the need for postpartum monitoring of women with prior GDM, not just for dysglycaemia, but for hypertension and other cardiovascular risk factors more broadly," wrote the authors of the study.

SOURCE

The study was led by C. Gómez Fernández and M. Charakida, both from Harris Birthright Research Centre for Fetal Medicine, King's College Hospital in London. It was published online on July 17 in Ultrasound in Obstetrics & Gynecology.

LIMITATIONS

The study cohort was identified through risk factor-based screening rather than universal biochemical testing. Follow-up was limited to a median of 5 months postpartum, precluding assessment of longer-term outcomes. The study design does not establish causality between GDM and postpartum hypertension.

DISCLOSURES

The study was supported by the Fetal Medicine Foundation. Canon Medical Systems Europe BV provided ultrasound machines and software free of charge. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.