Karoline Kragelund Nielsen

Aims: Moderate‐to‐vigorous physical activity (MVPA) and adequate, high‐quality sleep are important for cardiometabolic health in women with recent gestational diabetes mellitus (GDM) but are likely reduced during early motherhood. These behaviours may be associated; however, device‐measured sleep data and studies of these associations remain scarce in this population. This cross sectional study characterised MVPA and sleep patterns and examined their associations in women with recent GDM. Methods: In the Face‐it trial, 185 women provided device‐measured MVPA and sleep data 1 year after delivery. Sleep variables included duration and efficiency, reflecting sleep quantity and quality. Duration was categorised as 8 h/night. Associations with MVPA were analysed using linear mixed‐effects models with site as a random intercept, adjusted for potential confounders. Results: Two‐thirds (61.6%) met WHO recommendations for moderate‐intensity physical activity (PA), whereas few (3.2%) met recommendations for vigorous‐intensity PA. Most met recommendations for sleep duration (87.6%) and sleep efficiency (83.8%). Compared to 6–8 h/night, there was no difference in MVPA among those sleeping 8 h/night were associated with less MVPA (β = −13.5, 95% CI = −23.0, −4.0, p = 0.006). Sleep efficiency was positively associated with MVPA (β = 0.6, 95% CI = 0.1, 1.1, p = 0.018). Conclusions: The association between high‐quality sleep and greater MVPA suggests that PA and sleep may not only independently be relevant to cardiometabolic health but may also be associated in women with recent GDM.

Aims: Preeclampsia is associated with future cardiovascular disease (CVD), yet systematic approaches to identify those requiring intensified prevention are lacking. We aimed to characterize these women and identify subgroups at particularly high risk of later chronic hypertension or CVD. Methods and results: Using Danish nationwide registries, we followed primiparous women with preeclampsia who gave birth during 2004–18 until December 2022. Using Poisson regression models, we estimated incidence rate ratios (IRRs) of later chronic hypertension or CVD. Of 17 434 women with preeclampsia, 2372 developed chronic hypertension and 373 developed CVD. Early-onset preeclampsia was more common among those who later developed chronic hypertension (13.3% vs. 7.4%) or CVD (12.1% vs. 8.1%). Higher incidence rates (IRs) of both outcomes [IRRs (95% confidence interval) for chronic hypertension and CVD, respectively] were found for smoking in pregnancy [1.20 (1.05–1.36); 1.24 (0.86–1.80)], gestational diabetes [1.36 (1.19–1.56); 1.25 (0.80–1.94)], pre-existing Type 1 diabetes [2.09 (1.57–2.78); 1.89 (0.77–4.59)] and type 2 diabetes [1.47 (0.93–2.33); 1.47 (0.36–6.01)], and low education [1.50 (1.31–1.72); 2.77 (1.92–3.98)]. The regions with the highest IRR differed between outcomes, and IRs were higher than among Danish-born women for some regions and lower for others. Incidence rates also increased with higher body mass index (BMI) and age, more steeply above 25 kg/m2 and 40 years. Conclusion: Early-onset preeclampsia, smoking, co-existing diabetes, certain ethnic origins, lower educational level, higher maternal age at delivery, and pre-pregnancy BMI ≥ 25 kg/m2 were identified as risk factors for later chronic hypertension or CVD among women with preeclampsia.

Background: Childhood adversity has been shown to increase the risk of gestational diabetes mellitus (GDM), though the mechanisms through which the risk is increased have yet to be examined. Methods: We used register data on all women born in Denmark and giving birth for the first time between 2004 and 2018, totalling 207,659 women. Interventional mediation analysis was used to estimate how two mechanistic pathways, depression and pre-pregnancy BMI, mediate the relationship between childhood adversity and GDM across five previously identified adversity trajectory groups. Results: 4779 women were diagnosed with GDM between 2004 and 2018, corresponding to a 2.3% absolute risk of GDM. Compared to those who experienced low adversity in childhood, we estimated that those who experienced early material deprivation could have a 0.12% [95% CI 0.10, 0.14] reduction in absolute GDM risk by intervening on BMI and equalising its distribution to that of mothers in the low adversity group. We found no evidence of a reduction in risk if depression were similarly intervened on. For those in the high levels of adversity group no evidence of mediation was found. Conclusions: Intervening on pre-pregnancy BMI might potentially reduce the risk of GDM for mothers in some of the adversity groups, whereas intervening on depression seems to have little impact. The findings suggest that high adversity likely increases the risk of GDM through alternative mechanisms than BMI or depression.

Context: Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is associated with type 2 diabetes, which is associated with breast cancer and kidney cancer. However, little is known about the risk of cancer following a GDM diagnosis. Objective: This study aimed to test the hypothesis that a history of GDM associates with increased risk of breast, gynecological, thyroid, and kidney cancer. Methods: National cohort study, based on Danish registry data. The study population included a group of women exposed to GDM in their pregnancy leading to delivery between 2000 and 2019 or 1978 and 1997 and a 1:10 matched nonexposed group, matched on calendar period of delivery, the woman´s age (birth year), and the woman´s registered region of residence at delivery. Poisson regression adjusting for educational level was conducted. Results: Of the 314 742 deliveries included, 28 613 deliveries were in the exposed group and 286 129 in the nonexposed. The median follow-up time was 8.1 years. We found no increased risk of the selected cancers combined [adjusted incidence rate ratio (aIRR) 1.05; 95% confidence interval (CI), 0.94-1.18], breast cancer (aIRR 1.02; 95% CI, 0.89-1.17), gynecological cancer (aIRR 1.00; 95% CI, 0.79-1.26), or thyroid cancer (aIRR 1.26; 95% CI, 0.86-1.82). However, an increased risk of kidney cancer was seen in women with previous GDM compared with women without GDM (aIRR 1.92; 95% CI, 1.10-3.33), although it was a very small absolute risk. Conclusion: No elevated risk was found for the selected cancers combined. Women with previous GDM had an increased risk of kidney cancer, a rare cancer form.

Objectives: To develop and validate the Internalised Stigma Scale for Gestational Diabetes Mellitus (ISS-GDM), a questionnaire measuring self-reported internalised stigma among women with prior gestational diabetes mellitus (GDM). We hypothesised that internalised GDM stigma could be reliably and validly assessed through a short psychometric instrument. Design: Cross-sectional validation study. Setting: Follow-up data from the Danish, multicentre Face-it trial for women with prior GDM and their families. Participants: In total, 248 women completed the ISS-GDM approximately 1 year after their GDM affected pregnancy. Primary and secondary outcome measures: The primary outcome was psychometric properties of the ISS-GDM, assessed using Cronbach’s alpha, confirmatory factor analysis (CFA) and Rasch analysis (RA). Secondary outcomes included identification of item anomalies (local response dependence, differential item functioning). Results: A large proportion of respondents endorsed statements reflecting self-disappointment, self-blame and an altered self-perception. Less endorsed statements included feeling inferior to other mothers or guilt towards family members due to GDM. The ISS-GDM demonstrated satisfactory psychometric properties. CFA indicated that item 2 assessing self-perceived capabilities as a mother did not load onto the main factor, while CFA and RA identified local response dependence and differential item functioning by body mass index. After adjustments, a two-factor solution supported calculating a sum score of items 1 and 3–11, with item 2 retained as a stand-alone indicator of perceived parenting capabilities. The 10-item scale demonstrated acceptable reliability (Cronbach’s alpha=0.78). Conclusions: The ISS-GDM is a reliable and valid tool for assessing internalised stigma among women with prior GDM. Our findings further suggest that a substantial proportion of women with prior GDM experience self-blame and an altered self-perception due to their diagnosis. The ISS-GDM scale enables research into its prevalence, severity and consequences.

Aims: This study investigated the prevalence and concordance of cardiometabolic risk markers among couples after a gestational diabetes mellitus (GDM)‐affected pregnancy. It also examined whether selected demographic, socioeconomic and health behavioural factors could explain within‐couple associations. Materials and Methods: A cross‐sectional study design was used. We included health examinations and questionnaire data from couples assessed 12 weeks after a pregnancy affected by GDM. We determined the prevalence and concordance of cardiometabolic risk markers (overweight or obesity, high waist circumference, metabolic syndrome, impaired fasting glucose [≥6.1 mmol/L], and stage 1 hypertension or more [≥130 mmHg/≥80 mmHg], along with health behaviour [dietary quality and physical activity]). Results: A total of 196 couples were included. Overweight or obesity was present in 63.3% of women and 71.9% of partners, with concordance observed in 50.5% of couples. By comparison, 78.6% of women and 55.1% of partners had high waist circumferences, which was concordant in 48.5% of couples. Metabolic syndrome was identified in 9.2% of women and 24.0% of partners, suggesting a higher occurrence among partners with concordance in 5.1% of couples. Impaired fasting glucose was observed in 7.7% of women and 9.2% of partners, with concordance in 1.5% of couples. Stage 1 hypertension or more was observed in 31.1% of the women, 55.6% of the partners and concordant in 8.2% of couples. Cardiometabolic risk markers were associated within couples. Conclusions: Detecting GDM in women may serve as an opportunity to identify partners at risk, underscoring the potential of couple‐based or family‐focused interventions.

Aims: Low parental education during childhood may increase vulnerability to childhood adversities, which is known to increase the risk of gestational diabetes mellitus (GDM). We aimed to examine the joint association of parental education and childhood adversity on GDM risk.Methods: We used Danish nationwide register data of 206,819 women giving birth for the first time during 2004–2018. Five adversity groups were used to measure childhood adversity: low adversity, early material deprivation, persistent deprivation, loss or threat of loss, and high adversity. We examined the joint association of parental education and childhood adversity on GDM risk through interaction at the multiplicative and additive scale, using three levels of parental education: low, medium and high education, with high education and low adversity as the referent group.Results: 4758 (2.3%) women were diagnosed with GDM in the study population. We found a significant joint association of parental education and childhood adversity on GDM risk. Women with a low parental education level and who experienced loss or threat of loss had a higher risk of GDM compared to women with a high parental education level and low childhood adversity (OR 2.60 [95% CI 2.15; 3.12]). The additive scale showed some additivity though did not reach statistical significance, and there was no evidence of interaction on the multiplicative scale.Conclusions: Having both exposure to low parental education and childhood adversity may further increase the risk of GDM. Structural interventions aimed at providing better support and resources for low socioeconomic status families may reduce the risk of GDM.