A Cohort Study Of Association Between Lifestyle And Early Cardiovascular Health Among Women With Prior Gestational Diabetes Mellitus History

ObjectivesTo explore the independent and accumulative effects of breastfeeding,physical activity,sleep duration,dietary patterns,smoking and alcohol consumption on early cardiovascular health among women with prior gestational diabetes mellitus（GDM）history.MethodsOur current study was based on the Ma’anshan Birth Cohort（MABC）,which recruited pregnant women at their first prenatal visit at Ma’anshan Maternal and Child Health Hospital from May 2013 to September 2014.Women diagnosed with GDM were followed up at the 6^thyear postpartum,and a total of 96 women with GDM were included.Lifestyle included breastfeeding,sleep duration,physical activity,diet,smoking,and alcohol consumption.si MS score,an early cardiovascular health assessment index,was calculated based on physical measurements,blood biochemical examination results,and general demographic information.Breastfeeding data data were collected from 42d postpartum and 3,6,12 and 18 months of follow-up.The rest of the information was collected at the 6^thyear postpartum follow-up.Linear regression was used to analyze the associations of breastfeeding,physical activity,sleep duration,dietary pattern,smoking and alcohol consumption,and cumulative healthy lifestyles on the cardiovascular health among women with prior GDM history.The cumulative score of healthy lifestyles was calculated by counting the number of healthy lifestyles they adopted,the higher the cumulative score they had,the healthier the lifestyles they adopted.ResultsAmong women with a history of GDM,compared with women who breastfed for 0 to2 months,postpartum si MS scores were significantly lower in those who breastfed for3 months and longer[3 to 8 months:（β=-0.64,95%CI:-1.17 to-0.11,P=0.018）,9 to 12 months:（β=-0.64,95%CI:-1.21 to-0.06,P=0.030）,≥13 months:（β=-0.76,95%CI:-1.33 to-0.18,P=0.010）].Regarding physical activity,compared with women who did not exercise at leisure time,women who exercised 150 min or more per week at leisure had significantly lower postpartum si MS scores（β=-0.63,95%CI:-1.10 to-0.17,P=0.009）.Regarding sleep duration,compared with women with more than 9h of sleep,the si MS score was significantly lower in women with 7h to 9h of sleep（β=-1.16,95%CI:-1.98 to-0.33,P=0.007）and<7h of sleep（β=-1.13,95%CI:-1.98 to-0.28,P=0.010）.No significant association was observed between dietary patterns,smoking or alcohol consumption and si MS score.After cumulative scoring of the three lifestyle,breastfeeding,physical activity,and sleep duration,compared with women with a cumulative score of 0 to 1,women with a score of 2（β=-0.78,95%CI:-1.27 to-0.30,P=0.002）and 3（β=-0.93,95%CI:-1.43 to-0.43,P<0.001）both had significantly lower si MS scores,and the higher the score was,the lower the si MS score was(P_trend=0.007).After dividing the women into two strata according to BMI（<24.0/≥24.0）at 6^thyear postpartum,it was found that in the overweight or obese group（BMI≥24.0）,women with a score of 2（β=-0.93,95%CI:-1.62 to-0.25,P=0.009）and 3（β=-1.10,95%CI:-1.78 to-0.42,P=0.002）had a significantly lower si MS score compared with women with a cumulative score of 0 to 1.In the non-overweight or obese group（BMI<24.0）,a significantly lower si MS score was only found in women with a score of 3（β=-0.83,95%CI:-1.52 to-0.15,P=0.019）compared to women with a cumulative score of 0 to 1.ConclusionsBreastfeeding and leisure time exercise were associated with a reduced risk of CVD in women with prior GDM,and long sleep duration was associated with a increased risk in women with prior GDM.Our study indicated women with a history of GDM,especially overweight or obese women,should abide by a healthy lifestyle to improve cardiovascular health.