Infertility, Gravidity, and Risk Of Diabetes among High-Risk Women in the Diabetes Prevention Program Outcomes Study

Catherine Kim*, Naji Younes, Marinella Temprosa, Sharon Edelstein, Ronald B. Goldberg, Maria G. Araneta, Amisha Wallia, Angela Brown, Christine Darwin, Uzoma Ibebuogu, Xavier Pi-Sunyer, William C. Knowler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: The extent to which infertility and pregnancy independently increase risk of diabetes and subclinical atherosclerosis is not known. Research Design And Methods: We conducted a secondary analysis of Diabetes Prevention Program (DPP) and the DPP Outcomes Study over a 15-year period. We included women who answered questions about gravidity and infertility at baseline (n = 2085). Infertility was defined as > 1 year of unsuccessful attempts to conceive; thus, women could have histories of infertility as well as pregnancy. Risk of diabetes associated with gravidity and infertility was calculated using Cox proportional hazards models adjusting for age, race/ethnicity, treatment arm, body mass index, and pregnancy during the study. Among women who underwent assessment of coronary artery calcification (CAC) (n = 1337), odds of CAC were calculated using logistic regression models with similar covariates. Results: Among premenopausal women (n = 1075), women with histories of pregnancy and infertility (n = 147; hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.30, 2.49) and women with histories of pregnancy without infertility (n = 736; HR 1.49; 95% CI 1.15, 1.93) had greater diabetes risk than nulligravid women without infertility (n = 173). Premenopausal nulligravid women with histories of infertility had a non-significant elevation in risk, although the number of these women was small (n = 19; HR 1.63; 95% CI 0.88, 3.03). Associations were not observed among postmenopausal women (n = 1010). No associations were observed between infertility or pregnancy with CAC. Conclusions: Pregnancy, particularly combined with a history of infertility, confers increased risk of diabetes but not CAC among glucose-intolerant premenopausal women.

Original languageEnglish (US)
Article numberdgaa013
JournalJournal of clinical endocrinology and metabolism
Issue number3
StatePublished - Jan 8 2020


  • coronary artery calcification
  • diabetes
  • infertility
  • pregnancy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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