To assess whether gestational diabetes mellitus (GDM) is associated with an increased risk of heart failure (HF).

We conducted a population-based cohort study using information from the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. We identified all women in Ontario with a GDM diagnosis with a live birth singleton delivery between 1 July 2007 and 31 March 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization over a period extending from the index pregnancy until 31 March 2019. The secondary outcome was prevalent peripartum cardiomyopathy at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors.

Among 906,319 eligible women (mean age 30 years [SD 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median follow-up period of 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR] 1.62 [95% CI 1.28, 2.05]) compared with no GDM. This association remained significant after accounting for chronic kidney disease, postpartum diabetes, hypertension, and coronary artery disease (aHR 1.39 [95% CI 1.09, 1.79]). GDM increased the odds of peripartum cardiomyopathy (adjusted odds ratio 1.83 [95% CI 1.45, 2.33]).

In a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk for HF.

评估妊娠期糖尿病 (GDM) 是否与心力衰竭 (HF) 风险增加相关。

我们利用来自加拿大安大略省卫生部和长期护理部医疗保健管理数据库的信息进行了一项基于人群的队列研究。我们确定了 2007 年 7 月 1 日至 2018 年 3 月 31 日期间安大略省所有诊断为 GDM 且单胎活产的妇女。怀孕前患有糖尿病或心力衰竭的妇女被排除在外。 GDM 是根据实验室测试结果和诊断编码来定义的。主要结局是从首次妊娠到 2019 年 3 月 31 日期间发生的心衰住院事件。次要结局是初次妊娠时流行的围产期心肌病。根据相关心脏代谢危险因素调整关联估计。

在 906,319 名符合条件的女性（平均年龄 30 岁 [SD 5.6]，其中 50,193 名 GDM 患者 [5.5%]）中，中位随访期 7 年期间发生了 763 例心力衰竭事件。与无 GDM 相比，GDM 发生心力衰竭的风险较高（调整后风险比 [aHR] 1.62 [95% CI 1.28, 2.05]）。考虑到慢性肾病、产后糖尿病、高血压和冠状动脉疾病后，这种相关性仍然显着（aHR 1.39 [95% CI 1.09, 1.79]）。 GDM 增加围产期心肌病的几率（调整后的比值比 1.83 [95% CI 1.45, 2.33]）。

在一项大型观察性研究中，GDM 与心力衰竭风险增加相关。因此，建议在怀孕期间进行糖尿病筛查，以识别有心力衰竭风险的女性。