The metabolic syndrome has been defined by the concomitant clustering of central obesity, dysglycemia, hypertension, hypertriglyceridemia, and low high-density lipoprotein (HDL) cholesterol . Currently, controversy exists regarding its underlying etiology, diagnostic criteria, and even its clinical relevance . Although this debate is ongoing, it is nevertheless established that the metabolic syndrome identifies a patient population at high risk for the future development of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).
Gestational diabetes mellitus (GDM) shares some similarity to the metabolic syndrome, in that: 1) it too has been the subject of long-standing debate regarding its diagnostic criteria and 2) it also identifies patients who are at high risk of developing T2DM and CVD in the future. Of note, the patient population identified by GDM (i.e. young women of child-bearing age) is much younger than that typically associated with the metabolic syndrome. Nevertheless, previous studies have shown that: 1) approximately 30–40% of women with a history of GDM exhibit the metabolic syndrome by 10 yr postpartum ; and 2) women with GDM have a 70% increased incidence of CVD compared with their peers, within just 11 yr after the index pregnancy . Interestingly, it has recently emerged that even mild glucose intolerance in pregnancy (i.e. less severe than GDM) is associated with increased long-term risks of T2DM and CVD, in both cases less than that of women with GDM but significantly higher than that of the general population. Thus, the spectrum of gestational glucose tolerance (i.e. from normal to mild glucose intolerance to GDM) appears to stratify young women with respect to their future diabetic and cardiovascular risk, much like the metabolic syndrome. In this context, we hypothesized that women with gestational dysglycemia may have an underlying latent metabolic syndrome at an early stage in its natural history. Therefore, our objective in this study was to characterize the relationship between glucose tolerance status in pregnancy and postpartum risk of the metabolic syndrome.
Subjects and Methods