Kidney Dysfunction Following Gestational Diabetes Mellitus

Key Points Kidney dysfunction was diagnosed at 5 months postpartum in 12% of women who had gestational diabetes mellitus. Three quarters of women (616; 75%) had at least one cardiometabolic risk factor. Postpartum diagnosis offers an opportunity for early intervention to reduce progression of kidney disease, including those from marginalized groups. Background Gestational diabetes mellitus (GDM) is associated with future maternal type 2 diabetes mellitus and cardiovascular phenotypes including CKD. We aimed to explore if features of CKD and associated cardiovascular disease risk factors were already present postpartum in women with GDM and if postpartum clinics could provide an early opportunity to reduce burden of disease in marginalized groups. Methods All women who had routine antenatal care at a tertiary maternity unit in the United Kingdom and developed GDM were invited to attend a 5-month postnatal visit between September 2023 and January 2025. Maternal demographic characteristics, medical history, and pregnancy outcome were recorded, and kidney dysfunction, dysglycemia, hypertension, adiposity, and dyslipidemia were assessed. Results In total, 817 (77%) of the 1064 eligible women attended the clinic. Women were more likely to attend if they were of Black race, had chronic hypertension, family history of diabetes mellitus, or required insulin and/or metformin as treatment for GDM control. Ninety-eight (12%) women had kidney dysfunction (urine albumin-creatinine ratio ≥3 mg/mmol [26.55 mg/g]): 97 (99%; eGFR <60 ml/min per 1.73 m 2 :1 (1%), but only 9 (9%) women with kidney dysfunction met diagnostic criteria for type 2 diabetes. There were 616 (75%) women with one or more cardiometabolic risk factors (kidney dysfunction, dyslipidemia, dysglycaemia, and/or hypertension) and 279 (34%), 84 (10%), and 13 (2%) with at least two, three, or four risk factors, respectively. Conclusions A high prevalence of microalbuminuria was identified in women who had previous GDM at 5 months after delivery, and the majority did not meet criteria for type 2 diabetes, but three quarters had cardiovascular risk factors.