Gestational Diabetes History and Cardiovascular Health Assessed by Life’s Essential 8 across Postpartum Intervals

BACKGROUND: Gestational diabetes is a well-established risk factor for cardiovascular disease. However, its long-term impact on postpartum cardiovascular health (CVH), particularly assessed via the Life's Essential 8 (LE8) metrics, remains unclear. METHODS: Data from the 2007 to 2018 National Health and Nutrition Examination Survey data set were analyzed for women aged ≥20 years with complete LE8 metrics and available gestational diabetes history data. LE8 scores (range, 0-100) comprehensively assessed CVH through 4 behavioral domains (diet, physical activity, nicotine exposure, sleep) and 4 biomedical domains (blood lipids, blood glucose, blood pressure, body mass index). Multivariable linear regression models, adjusted for sociodemographic covariates, evaluated associations between gestational diabetes history and mean LE8 scores (overall, biomedical, behavioral). Postpartum intervals were stratified into 10-year categories to examine temporal variations. RESULTS: Among 6721 participants (mean age, 53.12±15.95 years), 650 (9.7%) reported gestational diabetes history. Mean overall LE8 score was 63.72±13.52 (biomedical: 68.12±18.63; behavioral: 59.32±18.80). Adjusted models demonstrated significantly lower LE8 scores in gestational diabetes groups: total β=-3.88 (95% CI, -4.90 to -2.86), biomedical β=-7.88 (95% CI, -9.25 to -6.51). Subgroup analyses by age at gestational diabetes diagnosis revealed significantly greater LE8 score reductions in women with later-onset gestational diabetes (>35 years: β=-5.87, 95% CI -7.99 to -3.75) compared with earlier-onset (≤35 years: β=-3.37, -4.51 to -2.24). The adverse association between gestational diabetes history and CVH was predominantly concentrated within the first 2 decades postpartum, with progressively diminishing effects beyond this period (