SUN-535 - Antenatal Indicators in Gestational Diabetes for Predicting Long-Term Cardio-Kidney-Metabolic Syndrome: A Prospective Cohort Study

Aim
Using a prospective Gestational diabetes mellitus (GDM) follow-up cohort established at Peking University First Hospital, we aimed to characterize post-partum long-term health outcomes of GDM women and identify antenatal risk factors for cardio–kidney–metabolic (CKM) outcomes.
Method
Singleton women diagnosed with GDM (using IADPSG criteria) between 2007 and 2016 were enrolled. Primary outcomes were CKM syndrome stage and 10-year cardiovascular disease (CVD) risk estimated using the China-PAR model. Multivariable logistic regression was used. The analysis incorporated demographic characteristics, lifestyle, a comprehensive panel of antenatal biomarkers and clinical indices during different trimesters (including whole blood test, biochemical indicators, OGTT, TyG index, prognostic nutritional index, systemic immune-inflammation index, gestational weight gain, GDM subtype, and lactation status.
Results
316 women were included (mean age 46.2 ± 4.3 years), with a median postpartum follow-up of 13 years (range 12–15). CVD (including coronary artery calcification, carotid plaque, lower extremity vascular sclerosis or occlusion, and hypertension) were present in 38.6% of patients. Renal diseases (defined as a UACR ≥30 mg/g and/or eGFR < 60 mL/min/1.73m²) were identified in 9.0%. Metabolic abnormalities (including overweight/obesity, fatty liver disease, dysglycemia, hyperlipidemia, and metabolic syndrome) were observed in 85.8%. According to CKM syndrome, 8.9%, 8.2%, 56.6%, 25.6%, and 0.6% of participants were classified as stages 0, 1, 2, 3, and 4. In multivariable logistic regression analyses, higher leukocyte countsin late pregnancy (OR 1.22, 95% CI: 1.03–1.45; P = 0.02) was associated with advanced CKM stages (3–4); and higher hemoglobin levels (OR 0.98, 95% CI: 0.96–0.99; P = 0.047) and A1 subtype of GDM (OR 0.28, 95% CI: 0.11–0.72; P < 0.01) was associated with a lower risk of CKM stage 3–4. For 10-year CVD risk, higher educational attainment (OR 0.11, 95% CI: 0.01–0.99; P = 0.049), and 7–8 hours of sleep (OR 0.05, 95% CI: 0.004–0.73; P = 0.03) were protective against intermediate-to-high 10-year CVD risk , while breastfeeding for < 1 month was an independent risk factor (OR 12.48, 95% CI: 2.53–61.67; P < 0.01). None of the other covariates mentioned in the Methods section demonstrated significant predictive value.
Conclusion
Prior GDM women showed a significant burden of long-term cardiometabolic abnormalities. Advanced CKM syndrome was associated with late-pregnancy inflammatory, anemia and GDM subtype, while educational level and modifiable postnatal factors, sleep duration, breastfeeding, were linked to future CVD risk. These findings highlight the need for long-term, risk-stratified follow-up and early preventive interventions in this population.
This study was registered at ClinicalTrials.gov (NCT07119177).

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