American Journal of Obstetrics and Gynecology, 197(5), 492.e1‐492.e7. doi:10.1016/j.ajog.2007.03.033 Diabetes mellitus in the 21 years after a pregnancy that was complicated by hypertension: findings from a prospective cohort study Leonie K. Callaway MBBS, FRACP a ,b , Debbie A. Lawlor FFPH, PhD f , Michael O’Callaghan MBBS, FRACP d , Gail M. Williams PhD c , Jake M. Najman PhD c and H. David McIntyre MBBS, FRACP b ,e a Department of Internal Medicine, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, Australia b School of Medicine, University of Queensland, Brisbane, Australia c School of Population Health, University of Queensland, Brisbane, Australia d Mater Children’s Hospital, Brisbane, Australia e Departments of Endocrinology and Obstetric Medicine, Mater Health Services, Brisbane, Australia f Department of Social Medicine, University of Bristol, Bristol, England, UK. Objective The purpose of this study was to examine the relationship between hypertensive disorders of pregnancy (HDP) and self‐reported diabetes mellitus 21 years after delivery. Study Design The Mater‐University of Queensland Study is a prospective cohort study of women who received antenatal care at a major public hospital in Brisbane, Australia, between 1981 and 1984; 3639 women who completed the questionnaire at 21 years postpartum were included. Results Of the women without HDP, 7.4% reported a diagnosis of diabetes mellitus compared with 15.3% of the women with HDP (unadjusted odds ratio [OR], 2.03; 95% CI, 1.42, 2.91). After adjustment for all potentially explanatory variables, only prepregnancy body mass index (BMI) and BMI at 21 years after delivery resulted in attenuation of the association (fully adjusted OR, 1.76; 95% CI, 1.21, 2.56). In a smaller subgroup, waist circumference and BMI at 21 years had similar effects on point estimates (fully adjusted OR with BMI, 1.64 [95% CI, 1.11, 2.42]; fully adjusted OR with waist, 1.60 [95% CI, 1.08, 2.40]). Conclusion HDP are associated with reported diagnosis of diabetes mellitus 21 years after delivery. Key words: diabetes mellitus; hypertension; preeclampsia; pregnancy Women who experience hypertensive disorders during pregnancy (HDP) have an increased risk of ischemic heart disease, [1] , [2] , [3] , [4] and [5] hypertension, [2] and [5] stroke, [4] and [5] venous thromboembolism, [3] and [6] and death [4] and [7] over the long term. It has been recognized that the development of HDP is a marker of later health risk. 8 It has been suggested that preeclampsia may be an early manifestation of a tendency to insulin resistance 9 and, more recently, that it may occur in women with preexisting occult endothelial dysfunction in combination with preexisting insulin resistance. 10 Consistent with these hypotheses, The final peer‐reviewed version is available on the Publisher’s website at http://www.sciencedirect.com/science/journal/00029378