Longitudinal patterns of cardiometabolic risk factors, gestational diabetes, and diabetes

Clinical Significance: Type 2 diabetes mellitus (T2DM) is a common, costly, and morbid conditionaffecting over 13% of adults in the United States. The prevalence of T2DM has doubled since 1980, and there has been a resurgence in DM-related complications, including increases in age-adjusted mortality rates. Prevalence of T2DM and DM-related complications differs significantly by race/ethnicity with higher rates of both among non-Hispanic Blacks (NHB) and Hispanic adults compared with non-Hispanic whites (NHW). In addition to higher rates in racial/ethnic minorities, T2DM is more common in other disadvantaged populations (e.g. low socioeconomic status [SES]). Cumulative exposures to preventable, modifiable risk factors across the life course are largely responsible for T2DM risk, and ample evidence supports that T2DM can be prevented.Therefore, prevention of T2DM is critical, beginning as early as the prenatal period, to curb theintergenerational spread of metabolic risk. In particular, pregnancy is a unique metabolic stressor and thus, a critical period to address and understand a woman and offspring’s lifetime risk of T2DM.A large body of evidence has identified and highlights the presence of glucose intolerance in pregnancy or gestational DM (GDM) as a unique sex-specific risk factor in women for future risk of T2DM and DM-related complications. GDM commonly affects up to 10% of pregnancies in the US with disproportionately higher rates in NHB and Hispanic and lower SES women. GDM is associated with a 7-fold greater risk of incident T2DM as well as increased risk of developing hypertension, early subclinical atherosclerosis, and premature cardiovascular disease (CVD). However, prior reports identifying risks are based predominantly on retrospective study designs or limited pre-pregnancy data from established pregnancy cohorts. Therefore, it remains unclear whether a history of GDM increases cardiometabolic risk independent of prior and subsequent DM RF (i.e. is t