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American Journal of Kidney Diseases

Association Between Gestational Diabetes and Incident Maternal CKD: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Published:November 08, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.08.015

      Background

      Gestational diabetes mellitus (GDM) is associated with increased risk for diabetes mellitus, metabolic syndrome, and cardiovascular disease. We evaluated whether GDM is associated with incident chronic kidney disease (CKD), controlling for prepregnancy risk factors for both conditions.

      Study Design

      Prospective cohort.

      Setting & Participants

      Of 2,747 women (aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study in 1985 to 86, we studied 820 who were nulliparous at enrollment, delivered at least 1 pregnancy longer than 20 weeks’ gestation, and had kidney function measurements during 25 years of follow-up.

      Predictor

      GDM was self-reported by women for each pregnancy.

      Outcomes

      CKD was defined as the development of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urine albumin-creatinine ratio ≥ 25 mg/g at any one CARDIA examination in years 10, 15, 20, or 25.

      Measurements

      HRs for developing CKD were estimated for women who developed GDM versus women without GDM using complementary log-log models, adjusting for prepregnancy age, systolic blood pressure, dyslipidemia, body mass index, smoking, education, eGFR, fasting glucose concentration, physical activity level (all measured at the CARDIA examination before the first pregnancy), race, and family history of diabetes. We explored for an interaction between race and GDM.

      Results

      During a mean follow-up of 20.8 years, 105 of 820 (12.8%) women developed CKD, predominantly increased urine albumin excretion (98 albuminuria only, 4 decreased eGFR only, and 3 both). There was evidence of a GDM-race interaction on CKD risk (P = 0.06). Among black women, the adjusted HR for CKD was 1.96 (95% CI, 1.04-3.67) in GDM compared with those without GDM. Among white women, the HR was 0.65 (95% CI, 0.23-1.83).

      Limitations

      Albuminuria was assessed by single untimed measurements of urine albumin and creatinine.

      Conclusions

      GDM is associated with the subsequent development of albuminuria among black women in CARDIA.

      Index Words

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