To evaluate associations between gestational diabetes mellitus (GDM) and various incident cardiovascular disease (CVD) end points, considering the effects of the mediating role of type 2 diabetes and shared environmental/familial factors.

This population-based cohort study included 10,02,486 parous women in Denmark during 1978–2016. We used Cox regression to 1) examine the associations of GDM with overall and type-specific CVDs using full-cohort and sibling-matched analysis, 2) quantify the impact of type 2 diabetes after GDM using mediation analysis, and 3) assess whether these associations were modified by prepregnancy obesity or maternal history of CVD.

Women with a history of GDM had a 40% increased overall CVD risk (hazard ratio [HR] 1.40, 95% CI 1.35–1.45). Sibling-matched analyses yielded similar results (HR, 1.44; 95% CI 1.28–1.62). The proportion of association between GDM and overall CVD explained by subsequent type 2 diabetes was 23.3% (15.4–32.8%). We observed increased risks of specific CVDs, including 65% increased stroke risk and more than twofold risks for myocardial infarction, heart failure, and peripheral artery disease. The elevated overall risks were more pronounced among women with GDM and prepregnancy obesity or maternal history of CVD.

A history of GDM was associated with increased risks of overall and specific CVDs. Increased risks were partly explained by subsequent type 2 diabetes, and the need to identify other pathways remains important. Continuous monitoring of women with a history of GDM, especially those with prepregnancy obesity or maternal history of CVD, may provide better opportunities to reduce their cardiovascular risk.

评估妊娠期糖尿病 (GDM) 与各种心血管疾病 (CVD) 事件终点之间的关联，同时考虑 2 型糖尿病的中介作用和共同的环境/家族因素的影响。

这项基于人群的队列研究包括 1978-2016 年间丹麦的 10,02,486 名经产妇女。我们使用 Cox 回归来1）使用全队列和同胞匹配分析检查 GDM 与总体和特定类型 CVD 的关联，2）使用中介分析量化 GDM 后 2 型糖尿病的影响，以及3）评估这些是否相关性因孕前肥胖或母亲 CVD 病史而改变。

有 GDM 病史的女性总体 CVD 风险增加 40%（风险比 [HR] 1.40，95% CI 1.35–1.45）。同胞匹配分析产生了相似的结果（HR，1.44；95% CI 1.28–1.62）。GDM 与由随后的 2 型糖尿病解释的总体 CVD 之间的关联比例为 23.3% (15.4–32.8%)。我们观察到特定 CVD 的风险增加，包括中风风险增加 65% 以及心肌梗塞、心力衰竭和外周动脉疾病的风险增加两倍以上。总体风险升高在患有 GDM 和孕前肥胖或母亲有 CVD 病史的女性中更为明显。

GDM 病史与总体和特定 CVD 风险增加有关。风险增加的部分原因是随后的 2 型糖尿病，确定其他途径的需求仍然很重要。持续监测有 GDM 病史的女性，尤其是那些有孕前肥胖或母亲有 CVD 病史的女性，可能会提供更好的机会来降低她们的心血管风险。