Gestational Diabetes Mellitus Is a Significant Risk Factor for Long-Term Maternal Renal Disease

Context: Gestational diabetes mellitus (GDM) was found to be an independent risk factor for recurrent long-term type 2 diabetes mellitus, cardiovascular morbidity, and vascular endothelial dysfunction. However, data on the link between GDM and future risk for long-term maternal renal disease are limited. Objective: The purpose of this study was to investigate whether GDM poses a risk for subsequent long-term maternal renal morbidity. Design: A population-based noninterventional study compared the incidence of future renal morbidity in a cohort of women with and without previous GDM. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Setting: The study was conducted at the Soroka University Medical Center. Participants: The study population was composed of all singleton pregnancies in women who delivered between January 1988 and December 2013. Main Outcome Measure: The main outcome was diagnosis of renal morbidities. Results: Of 97 968 women who met the inclusion criteria, 9542 (9.7%) had at least 1 previous pregnancy with GDM. Using a Kaplan-Meier survival curve, we show that women with GDM had higher rates of total renal morbidity (0.1% vs 0.2%, for no GDM and with GDM, respectively; odds ratio, 2.3, 95% confidence interval, 1.4-3.7; P < .001). In addition, we found a significant dose-response association (using the chi(2) test for trends) between the number of pregnancies with GDM and future risk for renal morbidity (0.1%, 0.2%, and 0.4% for no GDM, 1 episode of GDM, and 2 episodes of GDM, respectively; P < .001). In a Cox proportional hazards model, adjusted for con-founders, GDM was independently associated with future renal morbidity. Conclusion: GDM is a significant risk factor for future maternal renal morbidity. The risk is more substantial for patients with recurrent episodes of GDM.