Kidney Dysfunction Following Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is associated with future maternal type 2 diabetes mellitus and cardiovascular phenotypes including chronic kidney disease (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 marginalised groups. All women who had routine antenatal care at a tertiary maternity unit in United Kingdom and developed GDM were invited to attend a five-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. 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%) of women had kidney dysfunction (urine albumin- creatinine ratio (UACR) ≥3 mg/mmol ((26.55mg/g)): 97 (99%; estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2:1 (1%), but only 9 (9%) of 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%), 13 (2%) with at least two, three or four risk factors respectively. A high prevalence of microalbuminuria was identified in women who had previous GDM at five-months after delivery and the majority did not meet criteria for type 2 diabetes, but three-quarters had cardiovascular risk factors.