Very long-term follow-up suggests a twofold increase in chronic kidney disease (CKD) risk among black women with pregnancies affected by gestational diabetes mellitus, reports a study in American Journal of Kidney Diseases.
The researchers analyzed data on 2747 women, aged 18 to 30, from the community-based “Coronary Artery Risk Development in Young Adults” (CARDIA) study. Of these, 820 women were nulliparous at baseline, had one or more pregnancies lasting 20 weeks or longer, and had available data on kidney function at up to 25 years of follow-up. Associations between gestational diabetes and CKD were assessed, with adjustment for a wide range of other factors.
Overall, 12.3% of women reported a pregnancy affected by gestational diabetes. At a mean follow-up of 20.8 years, 12.8% of women had developed CKD. Of 105 cases of CKD, 98 were defined by albuminuria only (urine albumin-creatinine ratio of 25 mg/g or higher).
Gestational diabetes was associated with an increased risk of CKD only among black women: adjusted hazard ratio (HR) 1.96 (95% confidence interval 1.04 to 3.67). For white women, the association was nonsignificant, with an HR of 0.65 (95% confidence interval 0.23 to 1.83). Among black women, CKD developed in 31.0% of those with gestational diabetes versus 15.6% of those without gestational diabetes. Among white women, the figures were 6.8% versus 10.0%, respectively.
The study was designed to determine whether gestational diabetes is associated with incident CKD, after controlling for prepregnancy factors associated with both conditions. The results show a significant long-term increase in CKD, defined by albuminuria, among black but not white women with a history of gestational diabetes. “Pregnancy may present a window of opportunity to identify women at risk for CKD and implement prevention strategies,” the researchers write [Dehmer EW, et al. Association between gestational diabetes and incident maternal CKD: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Kidney Dis 2017; DOI: http://dx.doi.org/10.1053/j.ajkd.2017.08.015].