Gestational diabetes may predict later kidney damage

By Naveed Saleh, MD, MS, for MDLinx
Published June 19, 2018

Key Takeaways

Women with gestational diabetes (GDM) may be at increased risk for early-stage glomerular hyperinflation and kidney pathology, according to a new study published in Diabetes Care.

“Increasing evidence supports that both UACR [urinary albumin-to-creatinine ratio] and eGFR [estimated glomerular filtration rate] are independently associated with higher rates of mortality and end-stage renal disease,” wrote primary author Shristi Rawal, PhD, postdoctoral fellow, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

“Identifying early risk factors that are associated with these renal function markers and are amenable to screening in primary care settings is hence critical to tackling the global burden of CKD [chronic kidney disease] and its adverse health sequelae,” added Dr. Rawal.

Despite GDM resolving shortly after delivery, it has been associated with later risk factors for renal impairment including dyslipidemia, hypertension, vascular dysfunction, and additional cardiometabolic abnormalities. Furthermore, emerging research links GDM to later renal pathology, although it’s unclear whether GDM is an independent risk factor for renal impairment.

Importantly, previous research linking GDM to renal pathology is based on retrospective or cross-sectional studies, without adjustments for pre-pregnancy BMI, a leading risk factor for GDM.

In this study, Dr. Rawal and fellow researchers followed the association between GDM history and biomarkers for renal impairment 9-16 years after pregnancy. They also examined whether GDM is a risk factor for renal impairment independent of diabetes progression.

The team analyzed long-term renal function in 607 women with GDM and 619 without GDM drawn from the Danish National Birth Cohort (DNBC) index pregnancy (1996-2002). They measured serum creatinine (mg/dL), urinary albumin (mg/L), creatinine (mg/dL) to derive eGFR and UACR, at a median follow-up period of 13 years. All results were adjusted for confounding variables, including BMI and hypertension.

Dr. Rawal and colleagues found that at follow-up, women with a history of GDM had increased UACR and eGFR compared with women without GDM or subsequent diabetes.

After adjusting for BMI and other covariates, however, only increases in eGFR were significant. This association held even in women who didn’t go on to develop diabetes and may reflect early glomerular filtration and kidney damage. Of note, only subjects who developed diabetes showed frank kidney damage.

One potential limitation of this study based on its observational nature is residual confounding, according to the researchers.

“These findings suggest that women with GDM-complicated pregnancies may represent a high-risk group that could benefit from regular monitoring for early-stage renal damage, timely detection of which may help clinicians initiate treatment to prevent or delay further disease progression,” concluded Dr. Rawal and colleagues.

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