Analysis of the association between history of gestational diabetes mellitus and hypertensive disorders in a subsequent pregnancy: a retrospective cohort study

Aim To investigate the association between history of gestational diabetes mellitus (GDM) and the risk of hypertensive disorders of pregnancy in subsequent pregnancy (s-HDP). Methods A retrospective cohort of 5, 928 women with two consecutive singleton deliveries was categorized by GDM status across pregnancies: GDM - / - (none), GDM + / - (GDM history without recurrence), GDM - / + (only GDM in subsequent pregnancy), and GDM + / + (GDM history with recurrence). The primary endpoint was the occurrence of s-HDP in subsequent pregnancy, with pre-eclampsia (s-PE) as a secondary endpoint. Multivariable regression assessed associations between GDM patterns and these endpoints. Stratified analysis was performed to identify high-risk subgroups. Results Only GDM + / + was significantly associated with increased s-HDP risk after full adjustment ( P <0.05). This association remained significant in subgroups with prior HDP, long interpregnancy interval (LIPI, ≥36 months), advanced maternal age, or overweight/obesity. For s-PE, the association with GDM + / + was attenuated after full adjustment ( P >0.05) but remained significant in women with LIPI ( P <0.05). Other GDM patterns showed no significant associations. Conclusion A history of GDM is independently associated with increased HDP in a subsequent pregnancy only when GDM recurs, particularly among high-risk women. In contrast, a history of GDM without recurrence showed no significant association with s-HDP. The PE association was strongest in women with long interpregnancy intervals.