Gestational diabetes mellitus (GDM) affects 9-25% of pregnancies. Undiagnosed or poorly managed GDM is associated with both short- and long-term complications in the fetus and mother. The pathogenesis of GDM is complex and has not yet been fully elucidated. Several biomarkers found in maternal serum have the potential for the early diagnosis of GDM. The aim of this narrative review was to explore novel biomarkers that have not been comprehensively described in previous reviews. We believe these biomarkers may allow for the detection of GDM in the early stages of pregnancy, enabling timely proper treatment and potentially preventing complications for both the mother and the fetus.

To estimate whether breastfeeding is associated with the estimated risk of long-term atherosclerotic cardiovascular disease (ASCVD) and whether this association varies with prior gestational diabetes mellitus (GDM).

We conducted a secondary analysis from the prospective HAPO (Hyperglycemia and Adverse Pregnancy Outcome) Follow-Up Study. The exposure was any breastfeeding (yes or no). The primary outcomes, measured 10-14 years after delivery with the Framingham Risk Score, were estimated ASCVD risk (composite of fatal and nonfatal coronary heart disease and stroke) over the subsequent 10- and 30-year time periods. Multivariable linear regression models were used and adjusted for baseline pregnancy covariates: field center, age, body mass index (BMI), height, smoking and alcohol use, parity, and time from delivery to ASCVD risk assessment. Secondarily, we examined whether the association between breastfeeding and ASCVD varied by GDM status (effect modification).

Of 4,540 individuals, the median age was 30.6 years at baseline. More than three-fourths (79.7%) reported breastfeeding, which did not vary by GDM status (79.5% vs 81.0%). At 10-14 years after delivery (median 11.6 years), individuals who breastfed had a lower estimated risk of ASCVD over the subsequent 10 years (2.3% vs 2.5%, adjusted β -0.13, 95% CI, -0.25 to -0.02) and 30 years (6.2% vs 6.9%, adjusted β -0.36, 95% CI, -0.66 and -0.05). The association between breastfeeding and estimated ASCVD risk varied significantly by GDM status: The protective effect of breastfeeding was greater for individuals with GDM for estimated 10-year ASCVD risk (GDM: adjusted β -0.52, 95% CI, -0.98 and -0.05; no GDM: adjusted β -0.09, 95% CI, -0.20 and -0.02; interaction P=.004) and 30-year ASCVD risk (GDM: adjusted β -1.33, 95% CI, -2.53 and -0.14; no GDM: adjusted β -0.25, 95% CI, -0.54 and 0.03; interaction P=.003).

Breastfeeding, particularly after an individual had GDM, was associated with a lower estimated risk of long-term ASCVD. These findings indicate the potential benefit of breastfeeding for long-term cardiovascular health, especially among those with GDM.

Avoiding Diabetes After Pregnancy Together with Moms (ADAPT-M) is a postpartum lifestyle modification program aimed at preventing type 2 diabetes mellitus (T2DM) after gestational diabetes mellitus (GDM). The purpose of the workshop was to bring together key stakeholders to support the contextual adaptation of ADAPT-M needed for effective implementation.

Participants were invited to a co-design workshop held on June 10th, 2024. Participants engaged in facilitator-led breakout groups to prioritize intervention and implementation components using the MoSCoW method. Data were analyzed using a deductive thematic analysis approach.

In total, 27 attendees and eight facilitators participated in the workshop. We identified a total of 11 themes distributed across the four MoSCoW categories. Themes included: comprehensive support and education, cultural sensitivity and inclusivity, integrated and personalized care, communication and accessibility, and community and peer support networks, among others.

Our findings support research development that aligns with a core outcome set for diabetes after pregnancy prevention interventions, correlates with current diabetes prevention programs after GDM, and further refines potential changes to ADAPT-M as it is implemented in the real-world setting. Future work can consider these components and co-design methods when developing diabetes prevention programs in high-risk postpartum women with GDM.

Both metabolic dysfunction-associated fatty liver disease (MAFLD) and gestational diabetes mellitus (GDM) during pregnancy are emerging as an adverse synergistic relationship of growing concern. This narrative review focuses on the maternal and fetal consequences associated with women who have MAFLD and/or GDM during pregnancy, including an exploration of long-term cardiometabolic risks for postpartum maternal and childhood health. We conclude that implementation of a life course approach to management of these high-risk women remains paramount.

Gestational diabetes mellitus (GDM) is linked to altered fetal development and an increased risk of offspring developing cardiometabolic diseases in adulthood. The mechanisms responsible are unclear; however, GDM is associated with altered fetoplacental vascularisation, fibrosis and endothelial dysfunction. In non-pregnant individuals with diabetes, similar vascular changes are attributed to disruptions in endothelial-to-mesenchymal transition (EndMT), a key process where endothelial cells adopt a mesenchymal phenotype. Here, we assess whether alterations in the fetoplacental macro- and microvasculature are attributed to EndMT, using human umbilical vein endothelial cells (HUVECs) and human term placental tissue, respectively. Transforming growth factor (TGF)-β2 and interleukin (IL)-1β induced morphological and molecular changes consistent with EndMT in both GDM and non-GDM HUVECs. The ability of TGF-β2 and IL-1β to alter expression of known EndMT regulators, VWF, TGFBR1, IL1B and IL1R1, was diminished in GDM HUVECs; however, all other hallmarks of EndMT were similar. In placental villous tissue, Slug and Snail, two key transcriptional regulators of EndMT, were detected in the villous stroma, suggesting that EndMT probably occurs in the placental microvasculature. We observed a reduction in endothelial marker genes PECAM1, VWF and CDH5 in GDM placentas, suggesting reduced placental vascularisation. This was accompanied by a reduction in EndMT regulators SNAI2, TGB2, TGFB3 and TGFBR2; however, there was no change in mesenchymal markers or other EndMT regulators. This suggests that there may be some alterations in EndMT in GDM but this probably does not fully explain the endothelial dysfunction and altered vascularisation that occurs in the fetoplacental vasculature in pregnancies complicated by GDM. KEY POINTS: Gestational diabetes mellitus (GDM) has been linked to altered placental vascularisation, fibrosis and endothelial dysfunction. Disruptions in endothelial-to-mesenchymal transition (EndMT), a process where endothelial cells adopt a mesenchymal phenotype, has been linked to vascular complications in diabetes, but EndMT in GDM has not been investigated. Transforming growth factor (TGF)-β2 and interleukin (IL)-1β induced morphological and molecular changes consistent with EndMT in GDM and non-GDM human umbilical vein endothelial cells (HUVECs). Although the expression of EndMT mediators, VWF, TGFBR1, IL1B, and IL1R1, was diminished in GDM HUVECs, other EndMT hallmarks were similar. Transcriptional regulators of EndMT, Slug and Snail, were detected in the human term placenta. Despite a reduction in endothelial markers, PECAM1, VWF and CDH5, as well as SNAI2, TGFB2/3 and TGFBR2 in GDM placenta, there was no change in mesenchymal or other EndMT markers. This suggests that, although there may be some changes to EndMT in GDM, the vascular dysfunction is probably not explained fully by alterations in EndMT.

Women with a history of gestational diabetes mellitus (GDM) have a high lifetime risk of developing type 2 diabetes. Diabetes prevention programmes may reduce this risk. However, challenges related to the successful implementation of diabetes prevention programmes after GDM exist. Our objective is to map the components of the effective implementation of diabetes prevention programmes after GDM. We also plan to connect the available evidence on the effective implementation of diabetes prevention programmes to the Consolidated Framework for Implementation Research.

We will conduct a scoping review following Levac's adaptation of Arksey and O'Malley's framework for scoping reviews. We will report it according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Using a peer-reviewed search strategy, we will search Medline, Embase, PsycInfo and Emcare for primary studies describing the effective implementation of diabetes prevention programmes after GDM. Study selection will be completed in DistillerSR by two independent reviewers. Data will be extracted by one reviewer and verified by a second reviewer for accuracy using data extraction forms in DistillerSR.

Ethics approval was not required. Study results will be published in a peer-reviewed journal and presented at relevant conferences.

This scoping review protocol was registered with Open Science Framework (OSF; preregistration, 15 April 2024; registration ID: 10.17605/OSF.IO/MPNQD).

Hormonal fluctuations across the female reproductive lifespan lead to physiological adjustments that impact insulin sensitivity and glucose metabolism, generating unique challenges in diabetes management. Although current guidelines focus primarily on diabetes care during pregnancy, they lack tailored recommendations for addressing glycaemic variability associated with menstrual cycles, contraceptive needs, and menopause. Low rates of prepregnancy counselling, limited contraceptive guidance, and underuse of hormone replacement therapy further complicate care for women with diabetes. Here we examine these care gaps, identify unmet needs across reproductive stages, and suggest research directions to develop comprehensive, stage-specific management strategies that better support women's health and improve diabetes outcomes throughout the reproductive years.

Hypertensive disorders of pregnancy and gestational diabetes mellitus are characterized by vascular dysfunction and are associated with long term cardiovascular risks.

This study aimed to compare different markers of maternal vascular function in women with gestational diabetes mellitus, preeclampsia, or gestational hypertension and in women whose pregnancies were unaffected by these complications and to assess the association between maternal vascular function and markers of placental perfusion and maternal vascular-placental axis in 4 groups of women.

This was a prospective observational study of women who had routine hospital visits at 35 0/7 to 36 6/7 weeks of gestation at King's College Hospital, London, United Kingdom. The routine hospital visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, Doppler studies of the uterine arteries and ophthalmic arteries, carotid-femoral pulse wave velocity measurements, estimation of the augmentation index and total peripheral resistance, and measurements of serum placental growth factor and soluble fms-like tyrosine kinase 1. Linear regression analysis was performed for the outcomes of uterine artery pulsatility index multiple of the median, placental growth factor multiple of the median, and soluble fms-like tyrosine kinase 1 multiple of the median. The ophthalmic artery peak systolic velocity ratio, pulse wave velocity, augmentation index, and total peripheral vascular resistance were assessed as potential predictors. This analysis was performed on all women and separately in the different groups.

The study population of 6502 women included 614 (9.4%) with gestational diabetes mellitus, 140 (2.1%) who subsequently developed preeclampsia, and 129 (2.0%) who developed gestational hypertension. Women with gestational diabetes mellitus had increased pulse wave velocity compared with those with pregnancies unaffected by gestational diabetes mellitus, preeclampsia, or gestational hypertension. Women with preeclampsia or gestational hypertension had lower placental growth factor multiple of the median and higher uterine artery pulsatility index multiple of the median, soluble fms-like tyrosine kinase 1 multiple of the median, augmentation index, pulse wave velocity, total peripheral resistance, and ophthalmic artery peak systolic velocity ratio than those with unaffected pregnancies. In women with unaffected pregnancies, the ophthalmic artery peak systolic velocity ratio was predictive of the uterine artery pulsatility index multiple of the median, and ophthalmic artery peak systolic velocity ratio, augmentation index, total peripheral resistance, and pulse wave velocity were predictive of the placental growth factor multiple of the median and the soluble fms-like tyrosine kinase 1 multiple of the median. In women with gestational diabetes mellitus, the ophthalmic artery peak systolic velocity ratio was predictive of the uterine artery pulsatility index multiple of the median; the ophthalmic artery peak systolic velocity ratio, total peripheral resistance, and pulse wave velocity were predictive of the placental growth factor multiple of the median; and total peripheral resistance was predictive of the soluble fms-like tyrosine kinase 1 multiple of the median. In women with preeclampsia, the ophthalmic artery peak systolic velocity ratio was predictive of the uterine artery pulsatility index multiple of the median, placental growth factor multiple of the median, and soluble fms-like tyrosine kinase 1 multiple of the median. In women unaffected by gestational diabetes mellitus, preeclampsia, or gestational hypertension, the ophthalmic artery peak systolic velocity ratio was predictive of the uterine artery pulsatility index multiple of the median, and the augmentation index, total peripheral resistance, pulse wave velocity, and the ophthalmic artery peak systolic velocity ratio were predictive of the placental growth factor multiple of the median and the soluble fms-like tyrosine kinase 1 multiple of the median.

In the third trimester of pregnancy, women with preeclampsia, gestational hypertension, and gestational diabetes mellitus present with increased arterial stiffness. In addition, women diagnosed with hypertensive complications showed increased peripheral vascular resistance. The ophthalmic artery peak systolic velocity ratio provided predictive information for placental perfusion and function in all pregnant women, whereas vascular indices were more informative for placental function in women with unaffected pregnancies and those with gestational diabetes mellitus than in those with preeclampsia or gestational hypertension. Our data suggest that vascular assessment in women during pregnancy not only may provide information about maternal vascular health but also can be used to provide information about individual risk factors for placental insufficiency. The selection of the vascular index will have to be tailored according to the maternal profile and pregnancy complication.

Personal care products frequently contain endocrine disrupting chemicals (EDCs) including parabens and phthalates, which can alter glucose metabolism. The postpartum period is a time of rapid metabolic change, but whether EDC-associated product use impacts postpartum glucose metabolism is unknown.

We included 270 participants from the Boston, MA-based Environmental Reproductive and Glucose Outcomes (ERGO) pregnancy cohort with data on self-reported personal care product use at ≤4 pregnancy visits (median: 11, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks). We quantified postpartum hemoglobin A1c (HbA1c), fasting insulin, fasting- and 2-h glucose post-75-g oral glucose tolerance test, and calculated homeostatic model assessment for insulin sensitivity (HOMA2-S) and beta-cell function (HOMA2-B). Using covariate-adjusted linear regression, we estimated visit-specific associations of product use with postpartum glycemic outcomes.

Associations of product use with postpartum glycemic measures were mixed. Users of certain hair products had lower postpartum insulin sensitivity compared to non-users (e.g., Visit1 hair gel/spray: 22.8% difference [95% CI: 39.2, -1.9] in mean HOMA2-S). Conversely, users of products like deodorant, liquid- and bar soap, had higher insulin sensitivity and lower glucose levels (e.g., postpartum deodorant: 32.1% difference [95% CI: 7.0, 63.1] in mean HOMA2-S; -3.1 mg/dL [95% CI: 6.3, -0.04] mean fasting glucose). Associations with other products were inconsistent across timepoints or null.

Use of certain personal care products during the perinatal period was associated with altered postpartum glucose metabolism. Larger studies are needed to understand the impacts of product use patterns on glycemic outcomes.

Non-traditional cardiovascular risk factors (RFs) are increasingly emerging as important modifiers of cardiovascular risk (CVR), offering insights beyond traditional metrics like hypertension, diabetes, and dyslipidemia. These include novel biomarkers, chronic conditions (e.g., chronic kidney disease and chronic obstructive pulmonary disease), environmental exposures, chronic inflammation, infections, psychosocial factors, and sex-specific conditions, all of which influence the prediction, management, and outcomes of cardiovascular disease (CVD). These additional RFs may impact on CVD prediction and add valid information during tailored patient assessment and management. Therefore, a careful assessment of both traditional and non-traditional cardiovascular RFs, with a personalized treatment, could dramatically reduce the total CVD burden. Nevertheless, further research is needed to precisely estimate the magnitude of their impact as risk and prognosis modifiers in order to be included in future risk charts. This review provides a critical analysis of non-traditional RFs, their pathophysiological mechanisms, and their implications for personalized care. Integrating these factors into CVR assessment can reclassify patient risk categories, optimize therapeutic strategies, and improve prognosis. However, further research is needed to refine their inclusion in risk charts and evaluate their impact on public health outcomes. A tailored, multidisciplinary approach is essential to reduce the burden of CVD and associated mortality.

Gestational diabetes mellitus (GDM) is a condition characterized by hyperglycemia and is associated with increased risk of obesity and diabetes in exposed children. Differences in human milk composition between women with (GDM+) and without GDM (GDM-) suggest that GDM could impact milk production and composition, potentially influencing infant growth. However, this association remains poorly understood. The objective was to study the association between GDM and human milk composition and its influence on infant growth, focusing on metabolites and bioactive molecules involved in energy metabolism.

Using a cross-sectional design, 24 metabolites were measured by GC-MS in human milk obtained at 2 months postpartum from 20 GDM+ women and 29 GDM- women. Anthropometric measures, as well as lipid and glycemic profiles, were collected. Infant weight and length data were obtained from health records.

Human milk metabolites significantly differ between GDM+ and GDM- mothers, with higher levels of myristic acid, glycerol, uracil, arachidonic acid, and cholesterol in GDM+ milk (p < 0.05). Specific human milk metabolites showed distinct correlations with maternal glycemic as well as infant growth, depending on GDM status. While maternal glycemia was associated with succinate and malate in all groups, maternal glycemia was specifically correlated with valine and glutamate in GDM+ mothers. Additionally, in GDM+ women, α-ketoglutarate and glycine were negatively correlated with infant growth.

The results of this study suggest that GDM can influence the mother's health beyond delivery, impacting the mammary gland biology with effects on the human milk composition. Further, correlations with infant growth suggest that GDM-dependent variations in milk composition potentially influence infant growth and metabolism.

Gestational diabetes mellitus (GDM) increasingly affects women and predisposes both mothers and their infants to short- and long-term health consequences. Emerging research links GDM to maternal gut microbiota dysbiosis. However, the impact of GDM on the infant gut microbiota remains unclear. This cross-sectional study aims to explore potential associations between GDM and the gut microbiota in mothers and their infants, as well as correlations between maternal diet, cardiometabolic profile, and gut microbiota composition.

Gut microbiota taxonomic composition was characterized by 16S rRNA gene sequencing on fecal samples collected at 2 months postpartum from 28 mothers, including 17 with (GDM+) and 11 without (GDM-) GDM, as well as 30 infants, 17 GDM + and 13 GDM-. Variations in overall composition and specific taxa between GDM + and GDM- were assessed. Correlations between maternal cardiometabolic profile, dietary intakes, and taxa were performed.

GDM was associated with the overall composition of gut microbiota between GDM + and GDM- in the maternal group, but not in infants. No statistically significant difference in alpha diversity between groups was found in either mothers or infants. However, 14 taxa showed significantly different abundance between GDM + and GDM- mothers, and 4 taxa differed in infants. Specific taxa at the family rank were correlated with maternal dietary and cardiometabolic variables in both mothers and infants.

GDM exposition was associated with gut microbiota composition in both mothers and infants at two months postpartum. This study enhances our understanding of how maternal health could be linked with the gut microbiota of mothers and their infants.

NCT02872402 (2016-08-04, https://clinicaltrials.gov/study/NCT02872402?term=NCT02872402&rank=1 ) and NCT04263675 (2020-02-07, https://clinicaltrials.gov/study/NCT04263675?term=NCT04263675&rank=1 ).

Relatively few studies have examined the association between the entire spectrum of adverse birth outcomes [stillbirth, preterm birth (PTB), term births that are low birth weight (LBW) or high birth weight (HBW)] and long-term risk of CVD in the mother. Our objective was to examine the association between birth outcomes and risk of premature CVD or death in a contemporary cohort of pregnant women.

We conducted a retrospective population-based cohort study of women in Alberta, Canada, between 01/01/2005 and 01/01/2023. The primary endpoint was a composite of CVD-related hospitalization, CVD-related emergency department visit, or death. Cox proportional hazard modelling was used to examine the independent association between birth outcomes and the risk of CVD or death in the mother, after accounting for other socio-demographic, clinical and pregnancy-related complications.

Among 502,383 mothers, 0.51% had stillbirth, 7.11% had PTB, 86.11% had normal birth weight (NBW), 2.11% had LBW, and 4.15% had HBW. During a median follow-up of 3612 days (∼10 years), compared the NBW group, the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for maternal CVD or death associated with stillbirth was 1.63 (1.33, 1.99); 1.45 (1.36, 1.55) for PTB; 1.22 (1.06, 1.41) for LBW, and 1.13 (1.03, 1.23) for HBW. In addition to birth outcomes, pre-existing diabetes (aHR: 1.61, 95% CI: 1.47, 1.76), gestational hypertension (aHR: 1.47, 95% CI: 1.38, 1.57), and pre-existing hypertension (aHR: 3.28, 95% CI: 2.66, 4.04) carried a higher risk for premature CVD and death in the mother.

Adverse birth outcomes of stillbirth and preterm birth, and to a lesser degree term births that result in LBW or HBW, are markers of increased risk of premature CVD and death in the mother. Coordinated effort between obstetricians, family physicians, and cardiologists are needed to design and implement effective risk reduction programs tailored for these high-risk women.

Gestational diabetes mellitus (GDM) is regarded by many as maternal maladaptation to physiological insulin resistance during the second half of pregnancy. However, recent evidence indicates that alterations in carbohydrate metabolism can already be detected in early pregnancy. This observation, the increasing prevalence of GDM, and the significant short and long-term implications for the mother and offspring call for reevaluation of the conceptual paradigm of GDM as a syndrome. This review will present evidence for the syndromic nature of GDM and the controversies regarding screening, diagnosis, management, and treatment.

The aim of this review was to discuss cardiometabolic risk factors that affect women.

Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women.

Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

The ophthalmic artery, which is the first branch of the internal carotid artery, has a Doppler velocity waveform with 2 systolic peaks. The ratio of the peak systolic velocity of the second wave divided by that of the first wave is used to reflect increased peripheral resistance. Previous studies in the first, second, and third trimesters of pregnancy have reported that in pregnant women who subsequently develop preeclampsia, the peak systolic velocity ratio is increased. Both preeclampsia and gestational diabetes mellitus are associated with endothelial dysfunction and an increased risk for cardiovascular diseases during the first decade after pregnancy.

This study aimed to compare the ophthalmic artery peak systolic velocity ratio at 11 to 13 weeks' gestation of women who subsequently develop gestational diabetes mellitus with that of unaffected pregnant women and those who develop preeclampsia.

This was a prospective observational study of women who attended the King's College Hospital, London, United Kingdom, for a routine hospital visit at 11+0 to 13+6 weeks' gestation. This visit included recording of the maternal demographic characteristics and medical history, an ultrasound examination for fetal anatomy and growth, assessment of the flow velocity waveforms from the maternal ophthalmic arteries, calculation of the peak systolic velocity ratio, and measurement of the mean arterial pressure. Linear regression was performed to predict the ophthalmic artery peak systolic velocity ratio based on maternal characteristics and the mean arterial pressure. The peak systolic velocity ratio in the group with gestational diabetes mellitus was compared with that of preeclamptic and unaffected pregnancies.

A total of 3999 women were included in this study, including 375 (9.8%) who developed gestational diabetes mellitus and 101 (2.5%) who developed preeclampsia. In the gestational diabetes mellitus group, 161 (43.3%) were treated by diet alone, 130 (34.1%) were treated with metformin, and 84 (22.6%) received insulin with or without metformin. Prediction of peak systolic velocity ratio was provided by development of preeclampsia, maternal age, body mass index, mean arterial pressure, first-degree family history of diabetes mellitus, family history of preeclampsia, Asian ethnicity, and smoking. There was no significant contribution from gestational diabetes mellitus. Among women who developed gestational diabetes mellitus that required insulin treatment, the ophthalmic artery peak systolic velocity ratio (0.67±0.09) was higher (P<.001) than that in unaffected pregnancies (0.63±0.10), but it was not significantly different from that in the preeclampsia group (0.69±0.10; P=.90).

Among women who developed severe gestational diabetes mellitus that required insulin treatment, there was evidence of increased peripheral resistance, which was apparent from the first trimester of pregnancy.

We aimed to develop the health behaviour scale for gestational diabetes mellitus patients (HB-GDM) and evaluate its psychometric properties. The scale may provide theoretical basis and evidence for identifying the pathways to enhance health behaviours and optimise health management strategies.

The initial constructs and items of the scale were developed through literature review, qualitative analysis and Delphi expert consultation based on the socio-ecological model. Item analysis was conducted by four methods and using a sample (n = 235) recruited in China to form formal scale. Additional participants (n = 505) completed survey to measure the internal consistency reliability, test-retest reliability, content validity, construct validity and criterion-related validity of scale.

The scale contains six dimensions with a total of 29 items. The Cronbach's α of the scale was 0.912, McDonald's ω of the scale was 0.936, test-retest reliability was 0.957, content validity was 0.935, The cumulative variance contribution rate of the six common factors was 77.488 % and CFA model had acceptable goodness-of-fit indices(χ2/df = 2.567, RMSEA = 0.079). The criterion-related validity was 0.827(P<0.01).

HB-GDM scale showed satisfactory psychometric properties and has strong specialisation and better applicability.

The scale is favourable for pregnant women with GDM to clarify their unhealth behaviours. It provided guidance regarding maternal and postpartum follow-up care and the formulation of women health care strategies with regional characteristics.

Background: Breastfeeding is widely regarded as the optimal method of infant nutrition. A notable benefit of breastfeeding is its potential to avert the development of childhood overweight and obesity. This assertion holds particular significance in the context of infants whose mothers have exhibited gestational diabetes, a condition that has been demonstrated to be associated with an increased risk of carbohydrate and/or fat disorders in offspring, potentially leading to the onset of overweight and obesity in later life. Objective: The objective of the present study was to examine the variations in the anthropometric dimensions of infants across three distinct time points during the initial year of life, with a particular focus on the correlation between infant feeding practices and the prevalence of gestational diabetes in maternal subjects. Additionally, this study encompassed an analysis of the disparities in anthropometric dimensions between infant males and females. Methods: The study population included 42 infants whose mothers had been diagnosed with gestational diabetes between the 24th and 28th week of pregnancy, as well as 28 infants of women without gestational diabetes. The infants' dietary habits, including breastfeeding, mixed feeding, and formula feeding, were assessed, and their anthropometric measurements were obtained at three time points: 7 ± 1 weeks postpartum, 6 months ± 1 week postpartum, and 12 months ± 1 week postpartum. The infants were measured for weight, length, head circumference, and thickness of the subscapular skin fold. We also calculated their BMI and Ponderal Index, and the measurements were referenced to WHO centile grids. Results: At 7 ± 1 weeks postpartum, exclusively breastfed infants exhibited higher weight compared to those who were mixed-fed or formula-fed (p = 0.03). However, at 1 year of age, breastfed infants demonstrated significantly lower weight compared to formula-fed infants (p = 0.019). Furthermore, at 12 months, breastfed boys exhibited lower weight, length, BMI, and lower subscapular skinfold thickness compared to formula-fed infants. Conclusions: Breastfeeding has been shown to play a pivotal role in preventing obesity in children. In the initial postnatal period, infants who are fed breast milk exhibit a higher weight compared to those who are fed formula. However, by the age of 12 months, the weight of breastfed infants typically falls below that of formula-fed infants. Diabetes during pregnancy has been observed to have no impact on the anthropometric dimensions of infants up to the age of one. Nevertheless, further research is necessary to comprehensively assess the long-term implications of maternal GDM in their offspring.

Gestational diabetes mellitus (GDM) is a pregnancy-specific condition that can cause serious complications for both the mother and the fetus. Preventing these complications requires optimum glycemic control. Skin autofluorescence (SAF) is a non-invasive and innovative method that evaluates the levels of advanced glycation end products, markers of hyperglycemia, that could aid in the optimum management of GDM-complicated pregnancies. This systematic review aims to assess SAF's potential utility in the prediction of short-term and long-term outcomes in GDM. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, with the protocol identifier CRD42024559012, we used "(skin autofluorescence OR SAF) AND (gestational diabetes mellitus OR GDM)" as a search criterion on the PubMed, Scopus, and Web of Science databases. After a rigorous selection process, we included five articles, which evaluated SAF values and GDM, SAF and pregnancies complicated by diabetes mellitus, and SAF and macrosomia. GDM diagnosis varies due to the different approaches among the major guidelines, leading to variations in interpretation and diagnostic thresholds. Across studies, this variability contributes to inconsistent SAF values. As a standardized and objective marker, SAF could provide a uniform criterion, improving GDM management. Further research is needed to validate its clinical utility.

This study aims to identify early metabolomic biomarkers of gestational diabetes mellitus (GDM) and evaluate their association with hepatic steatosis.

We compared maternal serum metabolomic profiles between women who developed GDM (n = 118) and matched controls (n = 118) during the first (10-14 gestational weeks) and second (24-28 gestational weeks) trimesters using ultra-performance liquid chromatography coupled with mass spectrometry. Mediation analysis was performed to evaluate the mediating role of metabolic dysfunction-associated steatotic liver disease (MASLD) in the relationship between metabolites and subsequent development of GDM. A refined prediction model was developed to predict GDM using established clinical factors and selected metabolites.

Significant alterations in circulating metabolites, including amino acids, bile acids, and phospholipids, were observed in the GDM group compared to controls during early pregnancy. Mediation analysis revealed that several metabolites, including glycocholic acid (proportion mediated (PM) = 31.9%), butanoyl carnitine (PM = 25.7%), and uric acid (PM = 22.4%), had significant indirect effects on GDM incidence mediated by hepatic steatosis. The refined prediction model composed of clinical factors and selected metabolites in the first trimester demonstrated higher performance in predicting GDM development than the established prediction model composed solely of clinical factors (AUC, 0.85 vs. 0.63, p < 0.001).

Women who developed GDM exhibited altered metabolomic profiles from early pregnancy, which showed a significant correlation with GDM, with MASLD as a mediator. Selected metabolomic biomarkers may serve as predictive markers and potential targets for early risk assessment and intervention in GDM.

WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: Gestational diabetes mellitus (GDM) is a common pregnancy complication with significant health risks. Early identification of women at high risk for GDM is crucial for timely intervention and improved outcomes. WHAT IS THE KEY RESEARCH QUESTION?: What alterations in circulating metabolites during early pregnancy are associated with subsequent GDM development? Does metabolic dysfunction-associated steatotic liver disease (MASLD) mediate the association between specific metabolites and GDM risk? WHAT IS NEW?: Significant alterations in bile acids, amino acids, phosphatidylethanolamines, and phosphatidylinositols were observed in early pregnancy sera of women who later developed GDM. MASLD significantly mediated the effects of several metabolites on GDM risk, with mediation proportions ranging from 9.7 to 31.9%. A refined prediction model composed of clinical factors and metabolites significantly improved the performance in predicting GDM development. HOW MIGHT THIS STUDY INFLUENCE CLINICAL PRACTICE?: These results provide new insights into early metabolic alterations associated with GDM development and highlight the potential mediating role of MASLD. This comprehensive metabolomic approach may contribute to the development of improved risk prediction models and targeted interventions for GDM prevention.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy that poses considerable risks to both maternal and fetal health. However, its effect on cardiac autonomic function, measured by heart rate variability (HRV), remains uncertain. This study aims to investigate potential alterations in cardiac autonomic function in women diagnosed with GDM.

In this cross-sectional study, 80 Kazakh pregnant women in their third trimester with GDM were enrolled from the endocrinology department of Aktobe Medical Center between January and April 2023. A control group of 30 third-trimester pregnant women without GDM was also selected from outpatient clinics in Aktobe City. HRV was measured with participants in a seated position. A nomogram was developed to predict GDM risk, integrating relevant parameters associated with the condition.

Women with GDM were found to be older than those in the control group (p=0.005), though there were no significant differences in education level, employment status, or parity between the two groups. GDM was associated with larger fetal size (p=0.035) and a higher incidence of miscarriages and abortions (p<0.05) compared to the control group. Additionally, obesity was more prevalent among women with GDM (p<0.05). HRV parameters showed no significant differences between the GDM group and healthy pregnant women. The nomogram demonstrated good predictive accuracy, with an area under the curve of 0.7847 in the training cohort.

The nomogram developed in this study may prove useful for clinicians and patients in making informed clinical decisions and assessing outcomes. Notably, no significant differences in HRV were observed between women with uncomplicated pregnancies and those with GDM.

Dementia is a debilitating condition with a disproportionate impact on women. While sex differences in longevity contribute to the disparity, the role of the female sex as a biological variable in disease progression is not yet fully elucidated. Metabolic dysfunctions are drivers of dementia etiology, and cardiometabolic diseases are among the most influential modifiable risk factors. Pregnancy is a time of enhanced vulnerability for metabolic disorders. Many dementia risk factors, such as hypertension or blood glucose dysregulation, often emerge for the first time in pregnancy. While such cardiometabolic complications in pregnancy pose a risk to the health trajectory of a woman, increasing her odds of developing type 2 diabetes or chronic hypertension, it is not fully understood how this relates to her risk for dementia. Furthermore, structural and functional changes in the maternal brain have been reported during pregnancy suggesting it is a time of neuroplasticity for the mother. Therefore, pregnancy may be a window of opportunity to optimize metabolic health and support the maternal brain. Healthy dietary patterns are known to reduce the risk of cardiometabolic diseases and have been linked to dementia prevention, yet interventions targeting cognitive function in late life have largely been unsuccessful. Earlier interventions are needed to address the underlying metabolic dysfunctions and potentially reduce the risk of dementia, and pregnancy offers an ideal opportunity to intervene. This review discusses current evidence regarding maternal brain health and the potential window of opportunity in pregnancy to use diet to address neurological health disparities for women.

The study aimed to evaluate maternal hemodynamic and vascular changes in women with small-for-gestational age(SGA) and large-for-gestational age(LGA) fetuses in the presence and absence of gestational diabetes mellitus(GDM).

Women at 35+0 to 36+6 weeks' gestation with and without GDM were included. Maternal demographics, ultrasound for fetal growth, Doppler studies of uterine and ophthalmic arteries, carotid-femoral pulse-wave velocity(PWV), augmentation index, cardiac output, and total peripheral resistance(TPR) were recorded. Multinomial logistic regression was used.

Of 11,132 women, 1,228(11.0%) developed GDM. In GDM pregnancies, 158(12.8%) delivered SGA and 136(11.1%) delivered LGA neonates, while non-GDM pregnancies had 1,051(10.6%) SGA and 806(8.1%) LGA neonates. In GDM and non-GDM women, SGA groups had the highest uterine artery pulsatility index(PI) percentiles, PWV and ophthalmic artery peak systolic velocity ratio. PWV was higher in the GDM SGA group compared to non-GDM SGA group. Cardiac output was lower in SGA groups when compared to the AGA group. In women with GDM, TPR, ophthalmic artery PSV ratio and uterine artery PI percentile had a positive association with the development of SGA.

Women with GDM and vascular dysfunction have higher risk to deliver SGA neonates. Maternal hemodynamic and vascular maladaptation could potentially explain the development of SGA in women with GDM.

Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.

Experiencing a maternal complication of pregnancy conveys a significantly higher risk of developing premature cardiovascular disease compared to having an uncomplicated pregnancy. Postpartum interventions that aim to improve lifestyle and modifiable risk factors for people in this cohort may reduce cardiovascular disease risk. This study will explore the experiences and barriers to attendance of patients referred to one such clinic located in South Australia.

This qualitative study conducted six focus groups comprised of two-six patients who had attended at least one postpartum intervention clinic appointment (N = 19). Audio recordings were captured and transcribed and NVivo was used to perform a thematic analysis.

Participants found the clinic informative as it educated them on their greater risk of cardiovascular disease and how to reduce this risk. They reported wanting more frequent appointments and the ability to opt in for additional contact, including newsletters and social media groups. We also identified several barriers to attendance, including an unclear clinic referral and appointment booking process, and missing clinic correspondence including appointment letters and pathology forms.

This study provides insight into the experiences of patients who attended a postpartum cardiovascular disease prevention clinic. The clinic model can be operated in different health care settings to become part of standardized care in the postpartum period for patients who have had a pregnancy complication. Refinement of the clinic model referral and booking processes could reduce potential barriers to patient attendance.

This study aimed to describe trends in incidence of gestational diabetes in Manitoba and within subgroups that often experience health inequities.

We leveraged provincial administrative health data to describe trends in gestational diabetes incidence between 1981 and 2019, stratified by subpopulations based on age, urbanicity, and neighbourhood-level average household income. We calculated yearly incidence across subgroups and annual percent change in incidence to assess trends over time. Geospatial mapping was used to visualize changes by neighbourhood cluster.

Gestational diabetes incidence increased from 1.3% to 8.6% between 1981 and 2019, with an upward inflection occurring around 2010. The annual percent change (APC) between 1981 and 2009, prior to the inflection point, was 1.9% (95% confidence interval [CI] 1.4% to 2.5%), and it was 11.7% (95% CI 8.9% to 14.7%) postinflection---from 2010 to 2019. After 2010, gestational diabetes incidence increased most among urban residents (APC 18.1%, 95% CI 13.9% to 22.5%), among those >35 years of age (APC 12.0%, 95% CI 8.4% to 15.7%), and among individuals in the highest socioeconomic status (SES) group (APC 14.8%, 95% CI 9.4% to 20.4%). Geospatial mapping showed that incidence increased more in neighbourhoods with the highest proportion of recent immigrants to Canada.

Incidence of gestational diabetes increased 6-fold in Manitoba over the past 20 years, particularly among those with high SES and higher age. Further research is required to clarify the role of screening practices in the trends observed in this work.

Pregnancy complications like gestational diabetes and hypertensive disorders increase maternal cardiovascular risk. However, evidence on how to best implement cardiovascular risk management (CVRM) in multi-ethnic contexts remains limited. Existing studies primarily focus on white populations, despite disparities in CVD risk and the risk of pregnancy complications across ethnic groups.

This study explores experiences, barriers, and improvements in postpartum CVRM from women's and healthcare providers' perspectives, aiming to enhance cardiovascular disease prevention in multi-ethnic contexts.

We conducted semi-structured interviews with 25 postpartum women who experienced hypertensive disorders of pregnancy or gestational diabetes, recruited to reflect diverse ethnic and socioeconomic backgrounds. Using a narrative approach, interviews covered CVRM experiences and preferences. Themes were triangulated with findings from 16 healthcare providers, including general practitioners, midwives, and specialists, discussing care delivery, optimal practices, and multi-ethnic considerations. Results were integrated in a patient journey map.

Significant dropout occurred at the transition from obstetric to primary care and during long-term monitoring, especially among ethnic minorities and women with lower socioeconomic status and disease severity. Women often lacked risk awareness and missed follow-ups when self-scheduling was required. Most supported tailored cardiovascular risk education, lifestyle interventions, and proactive outreach. Healthcare providers emphasized the need for interdisciplinary communication, regional protocols, and clearer guidelines, noting variability in general practitioners' support for routine monitoring.

Postpartum CVRM in multi-ethnic contexts could be improved with active outreach, better follow-up utilization, culturally tailored interventions, and regional multidisciplinary protocols to streamline care and address guideline inconsistencies.

Gestational diabetes mellitus (GDM) is a transitory form of diabetes occurring in pregnancy with maternal and neonatal health consequences if left untreated. GDM can, in most instances, be managed non-medically through self-care practices, such as eating healthy or engaging in physical activity. This is especially relevant in a global health context with scarce resources. There is no official definition of "GDM self-care"; hence, the content and delivery modes of such interventions may vary greatly. Therefore, this study aimed to landscape GDM self-care interventions in low- and middle-income countries according to the WHO's three dimensions of health.

PubMed, Embase, Global Health Library, and Web of Science were searched for published intervention studies that compared the effect of a self-care intervention to standard care or had no comparator. Studies that targeted women with GDM that reported maternal health and/or neonatal health outcomes (physical, mental, and social health outcomes) and were conducted in low- and middle-income countries were included in the review.

Twenty-nine studies (randomised controlled trials and non-randomised studies) were included in the review. No studies were conducted in low-income countries, and studies were primarily conducted in Asia. Most interventions were complex and contained several interacting elements in relation to content, delivery mode, duration, and modality. Most interventions aimed to improve the physical health dimension (n = 28; 96.6%), whilst the mental health (n = 11; 37.9%) and social health dimensions (n = 9; 31.0%) were addressed to a lesser extent.

Current GDM self-care interventions in LMICs are complex, and the content of self-care interventions overlaps with lifestyle and non-pharmaceutical interventions. It is recommended that the scientific community use a standardised terminology for such interventions and that future GDM intervention studies, as a minimum, use the core outcome set for GDM when developing future studies.

OSF Registries (2 December 2022) [ https://doi.org/10.17605/OSF.IO/PJZQ3 ].

Non-communicable chronic disease is a major contributor to morbidity and mortality with potentially modifiable lifestyle factors. In women, the menopausal transition modifies women's risk of chronic disease, and pregnancy-related complications have been highlighted as female-specific risk factors. Later reproductive years, before onset of menopause, may represent a window of opportunity for promotion of lifestyle modifications. The aim of this scoping review is to investigate which interventions promoting lifestyle modifications in women of later reproductive years may influence cardiometabolic and bone disease.

A search of three electronic databases (PubMed, Embase, CINAHL) in the English language was performed in January 2024. Eligible studies included women aged 40-55 participating in interventions focusing on lifestyle modification. Studies reporting outcomes related to cardiometabolic disease, bone disease or body composition were eligible for inclusion.

Improvements in body composition occurred following interventions focusing on aerobic physical activity. Interventions focusing on health promotion and education, incorporating both dietary and physical activity modifications, prevented weight gain and improved cardiometabolic outcomes. Interventions incorporating elements of behavioural theories enhanced patient-motivated lifestyle modifications, with effects on body composition and cardiometabolic outcomes.

Lifestyle modifications in later reproductive years have the potential to influence cardiometabolic and bone disease. Our findings reinforce the benefits of regular aerobic physical activity, as well as health education, for improving body composition and lipid profile. This information could contribute to the development of clinical guidelines for the prevention of chronic disease.

This study aimed to identify and evaluate risk factors associated with gestational diabetes mellitus (GDM) in mainland China.

Eight electronic databases were searched for literature published from January 2010 until December 2023. Heterogeneity was quantified using I2. Data were pooled by fixed or random effects models and expressed as odds ratio and 95% confidence intervals.

A total of 69 observational studies with an overall sample size of 2,138,032 Chinese women and 219,303 patients with GDM were included in the analysis. After adjusting confounders, older maternal age (OR = 1.12, 95% CI: 1.09-1.15), maternal age ≥35 years (OR = 1.96, 95% CI: 1.74-2.21), higher pre-pregnancy body mass index (OR = 1.24, 95% CI: 1.17-1.32), pre-pregnancy overweight (OR = 1.78, 95% CI: 1.64-1.92) or obesity (OR 2.52, 95% CI: 2.06-3.08), family history of diabetes (OR = 1.85, 95% CI: 1.58-2.17), history of GDM (OR = 4.09, 95% CI: 2.13-7.82), and elevated levels of fasting plasma glucose (OR = 2.54, 95% CI: 2.13-3.01), hemoglobin (OR = 1.47, 95% CI: 1.14-1.89) and serum triglycerides (OR = 1.69, 95% CI: 1.31-2.16) in early pregnancy were associated with an increased risk of GDM in mainland China. But gravidity ≥2 (OR = 1.06, 95% CI: 0.89-1.27), conception by assisted reproductive technology analyses (OR = 1.54, 95% CI: 0.95-2.51) were not associated with GDM, and parity ≥1 (OR = 0.88, 95% CI: 0.82-0.94) was related to lower risk of GDM. In available unadjusted studies, history of abortion (OR = 1.34, 95% CI: 1.31-1.37) increased risk of GDM, non-Han ethnicity (OR = 0.78, 95% CI: 0.59-1.03) and high school or lower education level (OR1.09, 95% CI: 0.94-1.26) showed no correlation with GDM.

The key risk factors for GDM in mainland China included older maternal age, maternal age ≥35 years, pre-pregnancy overweight or obesity, family history of diabetes, history of GDM, elevated levels of FPG, Hb, and serum TG in early pregnancy. Early identification and intervention for women at high risk should be performed to prevent the development of GDM.

Women with prior gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes, and lifestyle intervention (LSI) offered a decade after pregnancy is effective in preventing diabetes. However, since diabetes frequently onsets in the initial years following pregnancy, preventive actions should be implemented closer to pregnancy. We aimed to assess the effect of lifestyle interventions, compared to standard care, in reducing the incidence of diabetes following a pregnancy complicated by GDM.

We searched the Cochrane Library, Embase, MEDLINE, and Web of Science from inception to July 21, 2024, to identify randomized controlled trials (RCTs) testing LSI to prevent diabetes following gestational diabetes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated the risk of bias with the Cochrane Collaboration Risk of Bias tool RoB-2 and the certainty of the evidence with GRADE methodology. We used the DerSimonian-Laird random effects pooling method and evaluated heterogeneity with the I2 statistic and the Chi2 test.

We identified 24 studies involving 9017 women. In studies without high risk of bias (18 studies; 8,357 women), LSI reduced the incidence of diabetes by 19% (RR = 0.81; 95%CI 0.71.0.93). The effect was significant and more protective (RR = 0.78; 0.65, 0.94) in studies evaluating women with GDM identified specifically as at a higher risk of diabetes, compared to those intervening on women with GDM irrespective of risk (RR = 0.85; 0.70, 1.04). Similarly, when expressed in absolute terms, the overall number needed to treat (NNT) was 56 considering all studies, 71 for women with GDM irrespective of risk, and 31 for women with GDM at high risk. The intervention produced a lower weight gain (mean difference=-0.88 kg;-1.52, -0.23 for all studies; -0.62 kg;-1.22, -0.02 for studies without high risk of bias). The effects were robust in sensitivity analyses and supported by evidence of moderate certainty for diabetes and weight change.

LSI offered to women with GDM following pregnancy is effective in preventing type 2 diabetes, despite the small postpartum weight change. The impact of LSI on incidence reduction was greater for women with GDM at a higher diabetes risk.

Registration number CRD42024555086, Jun 28, 2024.

Ambient air pollution has been associated with gestational diabetes mellitus (GDM); however, evidence regarding trimester-specific effects from China remains limited. This case-control study study analyzed data from pregnant women who delivered in Wuhan, China, between 2017 and 2022 (164 GDM cases and 731 controls), integrating geographic information, air quality measurements, and maternal characteristics. Using Inverse Distance Weighting interpolation and Generalized Linear Mixed Models (GLMM), we assessed associations between air pollutant exposure and GDM across different gestational periods. Results indicated that NO2 demonstrated the strongest association with GDM compared to other pollutants. Specifically, increased NO2 exposure was consistently associated with higher GDM risk throughout pregnancy. PM2.5 exposure showed significant associations during early and mid-pregnancy, while SO2 exposure was significantly associated with GDM risk exclusively in early pregnancy. Sensitivity analyses stratified by urban maternity status and maternal age revealed the stability of the study's findings. These findings underscore the importance of reducing air pollution exposure during pregnancy and implementing targeted interventions for high-risk populations to prevent GDM development.

Pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), affect a significant proportion of women in Australia, with long-term implications for cardiovascular disease (CVD) risk. Despite existing preventive measures, participation in ongoing health monitoring remains low. This study aims to explore women's preferences and experiences regarding preventive healthcare after GDM and HDP, and to identify their unanswered questions about the association between these conditions and future CVD risk.

A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group (LEE Group) to plan, conduct, and interpret focus groups with women who had experienced either GDM or HDP. Participants were recruited through health consumer and community organisations and took part in two focus groups conducted via Zoom. The focus groups involved a stimulus presentation about CVD and GDM or HDP, facilitated group discussion about participants' health and healthcare since their pregnancy, and Nominal Group Technique to prioritise participants' questions about their CVD risk. Focus groups were audio recorded and transcripts from each group were analysed thematically. Synthesised Member Checking was used to verify the trustworthiness of findings.

Twelve women participated in the focus groups, with distinct themes emerging from the GDM and HDP focus groups. Participants were previously unaware of the association between their pregnancy complication and increased risk of future CVD and wished to know more. Three themes were generated from the GDM focus groups: 'a distressing diagnosis'; 'degrees of diabetes'; and 'balancing motherhood and self-care'. Two themes were generated from the HDP focus groups: 'women's concerns were dismissed' and 'wanting follow up at the right time and with the right person'. The 'top ten' questions from each group focussed on improving maternity care, preventing CVD, and (for the HDP group) concerns beyond CVD.

Women's capacity to engage in preventive health after GDM and HDP is influenced by their maternity care experiences and the accessibility of primary care pathways. Future interventions should focus on improving woman-centred maternity care, ensuring seamless transitions to primary care, and addressing the social determinants of health for new mothers.

Background/Objectives: No previous study has provided a comprehensive evaluation of all biventricular and biatrial myocardial strain parameters in women with previous gestational diabetes mellitus (pGDM). Accordingly, we aimed at investigating the structural and myocardial deformation properties of all cardiac chambers in a cohort of pGDM women at 4 years postpartum. Methods: A consecutive cohort of pGDM women was compared to a control group of healthy women with previous uncomplicated pregnancy, matched by age, ethnicity and gestational week, at 4 years postpartum. Both groups of women underwent transthoracic echocardiography (TTE) implemented with speckle-tracking echocardiography (STE) and subsequent carotid ultrasonography. The primary endpoint was subclinical myocardial dysfunction, defined as left-ventricular (LV) global longitudinal strain (GLS) < 20%, whereas the secondary endpoint was early carotid atherosclerosis, defined as common carotid artery (CCA) intima-media thickness (IMT) ≥ 0.7 mm. Results: A total of 32 pGDM women (39.1 ± 6.5 yrs) and 30 matched healthy controls (40.8 ± 5.0 yrs) were analyzed. Despite normal and similar systolic function on conventional TTE, all biventricular and biatrial strain parameters were significantly lower in pGDM women than controls. Mean follow-up period was 4.0 ± 1.9 yrs. During follow-up, 62.5% of pGDM women developed subclinical myocardial dysfunction, and 78.1% of them were diagnosed with early carotid atherosclerosis. Third-trimester BMI (OR 1.88, 95% CI 1.19-2.98) and third-trimester glycosylated hemoglobin (HbA1C) (OR 2.34, 95% CI 1.08-5.04) were independently associated with the primary endpoint. Third-trimester BMI and HbA1C also independently predicted the secondary endpoint. Third-trimester BMI > 27 kg/m2 and HbA1C > 33 mmol/mol showed the best sensitivity and specificity for predicting both endpoints. Conclusions: Women with a previous history of GDM complicated by overweight/obesity and uncontrolled diabetes have a significantly increased risk of subclinical myocardial dysfunction and early carotid atherosclerosis at 4 years postpartum.