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Gestational diabetes and risk of incident primary cancer: A large population-based cohort study in Israel.

1538 Background: Gestational diabetes mellitus, a state of glucose intolerance associated with pregnancy is increasing in prevalence. Data regarding the risk associated with Gestational diabetes is sparse and conflicting. The current study was conducted to examine the risk of incident over-all and site-specific malignancies associated with a history of gestational diabetes mellitus in a historical cohort study of women in Maccabi Healthcare Services, a large health maintenance organization in Israel.


METHODS
All women aged 15 to 50 years who underwent 50g glucose challenge tests between March 13, 1995 and May 27, 2009, without history of malignancy, diabetes or infertility were included. Clinical and demographic parameters at index date including age, socioeconomic level, BMI and parity were collected. Diagnosis of gestational diabetes was based on the 100g oral glucose tolerance test using the standard Carpenter & Coustan criteria. The main endpoint of the study was a diagnosis of cancer obtained from the Israel Cancer Register through linkage data.


RESULTS
Among the 185,315 women who had undergone glucose challenge during the study period, 11,264 (6.1%) were diagnosed with gestational diabetes. During a total follow-up period of 1.05 million person years, 2034 incident cases of cancer were identified. GDM was associated with a hazard ratio (HR) of 7.12 (95% CI: 1.71-29.67) for pancreatic cancer and a HR of 1.69 (95% CI: 0.96-2.97) for hematological malignancies. The association between GDM and hematological malignancies was limited to women with five or more years of follow-up (HR=4.43; 1.79-10.96).


CONCLUSIONS
Gestational diabetes mellitus is strongly associated with an increased long-term risk of pancreatic cancer and probably with hematologic malignancies.