Lifetime history of gestational diabetes and cognitive function in parous women in midlife,Diabetologia

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Lifetime history of gestational diabetes and cognitive function in parous women in midlife
Diabetologia ( IF 8.4 ) Pub Date : 2024-09-06 , DOI: 10.1007/s00125-024-06270-w
Diana C Soria-Contreras ₁ , Siwen Wang ₁ , Jiaxuan Liu ₂ , Rebecca B Lawn ₂ , Makiko Mitsunami ₁ , Alexandra C Purdue-Smithe ₃ , Cuilin Zhang _{1,

4,

5,

6} , Emily Oken _{1,

7} , Jorge E Chavarro _{1,

2,

8}

Affiliation

Aims/hypothesis

We aimed to determine whether a history of gestational diabetes mellitus (GDM) is associated with cognitive function in midlife.

Methods

We conducted a secondary data analysis of the prospective Nurses’ Health Study II. From 1989 to 2001, and then in 2009, participants reported their history of GDM. A subset participated in a cognition sub-study in 2014–2019 (wave 1) or 2018–2022 (wave 2). We included 15,906 parous participants (≥1 birth at ≥18 years) who completed a cognitive assessment and were free of CVD, cancer and diabetes before their first birth. The primary exposure was a history of GDM. Additionally, we studied exposure to GDM and subsequent type 2 diabetes mellitus (neither GDM nor type 2 diabetes, GDM only, type 2 diabetes only or GDM followed by type 2 diabetes) and conducted mediation analysis by type 2 diabetes. The outcomes were composite z scores measuring psychomotor speed/attention, learning/working memory and global cognition obtained with the Cogstate brief battery. Mean differences (β and 95% CI) in cognitive function by GDM were estimated using linear regression.

Results

The 15,906 participants were a mean of 62.0 years (SD 4.9) at cognitive assessment, and 4.7% (n=749) had a history of GDM. In models adjusted for age at cognitive assessment, race and ethnicity, education, wave of enrolment in the cognition sub-study, socioeconomic status and pre-pregnancy characteristics, women with a history of GDM had lower performance in psychomotor speed/attention (β −0.08; 95% CI −0.14, −0.01) and global cognition (β −0.06; 95% CI −0.11, −0.01) than those without a history of GDM. The lower cognitive performance in women with GDM was only partially explained by the development of type 2 diabetes.

Conclusions/interpretation

Women with a history of GDM had poorer cognition than those without GDM. If replicated, our findings support future research on early risk modification strategies for women with a history of GDM as a potential avenue to decrease their risk of cognitive impairment.

Graphical Abstract

中文翻译：

中年经产妇女妊娠糖尿病终生史和认知功能

目标/假设

我们的目的是确定妊娠糖尿病（GDM）病史是否与中年认知功能相关。

方法

我们对前瞻性护士健康研究 II 进行了二次数据分析。从 1989 年到 2001 年，以及 2009 年，参与者报告了他们的 GDM 病史。一部分人参加了 2014-2019 年（第一波）或 2018-2022 年（第二波）的认知子研究。我们纳入了 15,906 名经产参与者（≥18 岁时生育过 1 次），他们完成了认知评估，并且在第一次出生前没有患 CVD、癌症和糖尿病。主要暴露是 GDM 病史。此外，我们研究了 GDM 和随后的 2 型糖尿病暴露情况（既不是 GDM 也不是 2 型糖尿病、仅 GDM、仅 2 型糖尿病或 GDM 后发生 2 型糖尿病），并进行了 2 型糖尿病的中介分析。结果是使用 Cogstate 简短电池获得的综合z分数，测量精神运动速度/注意力、学习/工作记忆和整体认知。使用线性回归估计 GDM 认知功能的平均差异（β 和 95% CI）。

结果

15,906 名参与者的认知评估平均年龄为 62.0 岁 (SD 4.9)，4.7% ( n = 749) 有 GDM 病史。在根据认知评估年龄、种族和民族、教育程度、认知子研究的入学浪潮、社会经济地位和孕前特征进行调整的模型中，有 GDM 病史的女性在精神运动速度/注意力方面表现较低（β -与无 GDM 病史的患者相比，β -0.08；95% CI -0.14，-0.01）和整体认知（β -0.06；95% CI -0.11，-0.01）。患有 GDM 的女性认知能力较低只能部分归因于 2 型糖尿病的发生。