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Higher risk of diabetes after hypertensive disorders in pregnancy

PLoS Med 2013; doi:10.1371/journal.pmed.1001425 Women with hypertensive disorders in pregnancy have a higher risk of diabetes later in life, according to a data linkage study of more than one million women. Canadian researchers linked five of Ontario’s healthcare databases to compute risk of diabetes up to 17 years (median 8.5 years) after an index pregnancy.Womenwith pre-eclampsia (hazard ratio 2.08, 95% CI 1.97 to 2.19) or gestational hypertension (1.95, 1.83 to 2.07) had roughly twice the risk of women with neither condition in analyses adjusted for gestational diabetes and other confounding factors. The combination of a hypertensive disorder in pregnancy and gestational diabetes was associated with a higher risk than gestational diabetes alone. Should all women with hypertensive disorders in pregnancy be screened for diabetes? Not yet, says a linked comment (doi:10. 1371/journal.pmed.1001428). These analyses show a clear association in a very large population of women, but there is little evidence that systematic screening is cost effective even for women with a history of gestational diabetes, a condition much more powerfully associated with later diabetes. Furthermore, the authors weren’t able to adjust their associations for body mass index, a key confounder. For now, doctors should tell womenwith hypertensive disorders about the risk of later diabetes, advise them how to reduce it, and mention the possibility of screening if they want it.