Atherosclerosis 194 (2007) e72–e79 Should we consider gestational diabetes a vascular risk factor? S. Bo a,∗ , S. Valpreda b , G. Menato c , C. Bardelli c , C. Botto c , R. Gambino a , C. Rabbia b , M. Durazzo a , M. Cassader a , M. Massobrio c , G. Pagano a a Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy b Department of Vascular Interventional Radiology, S. Giovanni Battista Hospital, Turin c Department of Obstetrician and Gynaecology, University of Turin, Italy Received 30 April 2006; received in revised form 19 September 2006; accepted 27 September 2006 Available online 20 October 2006 Abstract Few and contrasting data have reported vascular endothelial dysfunction and increased serum levels of endothelial dysfunction and inflam- matory markers in women with previous gestational diabetes mellitus (pGDM). We aimed at evaluating 6.5 years after delivery: intimal medial thickness (IMT), and C-reactive protein (CRP), interleukin-6 (IL-6), E-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1) levels in 82 non-pregnant pGDM and 113 control women without pGDM. A subgroup of 21 women, taken from the pGDM group, showing current normal BMI, and no metabolic abnormalities, was separately analysed. All the subjects were free of medication and non-smokers. Women with pGDM, independently by their current BMI and presence of metabolic abnormalities, showed significantly higher E-selectin, ICAM-1 and IMT values than controls. IMT proved to be significantly associated with pGDM in a regression model, after adjustments for BMI, waist circumference, blood pressure, and glucose values (β = 0.046; 95% CI 0.028–0.064). In all pGDM women, E-selectin, ICAM-1, IL-6 and hs-CRP values were significantly associated with IMT in the same model. Post-GDM women, despite being currently free from metabolic abnormalities, showed higher values of markers of endothelial dysfunction and IMT than controls, consistent with an increased future cardiovascular risk. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: C-reactive protein; E-selectin; Intercellular adhesion molecule-1; Interleukin-6; Intimal medial thickness; Gestational diabetes; Vascular adhesion molecule-1 1. Introduction A major difficulty in the prevention of cardiovascular dis- eases (CVD) is identifying at risk individuals at an early enough stage to benefit from interventions. Recently, a great number of data have demonstrated that pregnancy complica- tions, such as pregnancy-induced hypertension, delivery of pre-term or low-birth-weight babies, spontaneous pregnancy loss are all conditions associated with substantial increase in CVD risk [1]. It has been hypothesised that either pregnancy ∗ Corresponding author at: Dipartimento di Medicina Interna, Universita’ di Torino, Corso Dogliotti 14, 10126 Torino, Italy. Tel.: +39 011 6967864; fax: +39 011 6634751. E-mail address: sbo@molinette.piemonte.it (S. Bo). complications “resets” the mothers’ metabolism adversely so directly increasing future CVD risk, or that unknown pre- existent cardiovascular risk factors are exacerbated by the metabolic stress of pregnancy thus contributing to gestational complications [1]. Therefore, the likelihood of pregnancy complications might have clinical implications, becoming an easy, no-cost tool to detect which women should undergo routine CVD assessment. Less attention has been focused on the relationship between gestational diabetes (GDM), a relatively frequent disease, affecting 2–5% of all pregnancies, and CVD in later years. On the other hand, the future risk of developing type 2 diabetes in women with previous GDM (pGDM) is well known, ranging from 20 to 60%, depending on the severity of their insulin resistance and plasma glucose reached during 0021-9150/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2006.09.017