Gestational Diabetes Mellitus and Incident Kidney Disease

KEY POINTS: In this large cohort, over 10 years, women with a history of gestational diabetes mellitus exhibited a high risk for overall kidney disease. This risk was already apparent in the early postpartum and more pronounced with two or more gestational diabetes mellitus episodes. Accounting for the history of gestational diabetes mellitus among women may help prevent kidney disease. BACKGROUND: The extent to which gestational diabetes mellitus (GDM) influences the risk of kidney disease remains unknown. We investigated the associations between GDM and incidence of kidney disease, including CKD and AKI. METHODS: This nationwide population-based cohort study included 1,441,317 parous women in France during 2012-2013. We used Cox regression to investigate the ( 1 ) association of GDM with incident hospitalization for AKI or CKD, ( 2 ) timing to postpartum GDM-related kidney disease, and ( 3 ) GDM recurrence and the incidence of kidney disease. RESULTS: Over a 10-year period, women with a history of GDM ( n =103,122 [7.2%]) had a 46% higher risk of CKD (adjusted hazard ratio [aHR], 1.46; 95% confidence interval [CI], 1.36 to 1.55) and a 18% higher risk of AKI (aHR, 1.18; 95% CI, 1.11 to 1.25), compared with those without a history of GDM. Accounting for postpartum incident hypertension and type 2 diabetes attenuated effect estimates-10% for CKD (aHR, 1.10; 95% CI, 1.02 to 1.19) and 1% for AKI (aHR, 1.01; 95% CI, 0.95 to 1.08). The elevated risk of kidney disease was apparent at 1 year postpartum and more pronounced among women with two or more GDM episodes than among those with one GDM episode. CONCLUSIONS: GDM was mainly associated with an increased risk of CKD, which is present early in the postpartum and higher among women with repeated GDM.