{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:44:08Z","timestamp":1788986648770,"version":"build-2803163510"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec id=\"ab-ioi230060-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Gestational diabetes has been associated with numerous chronic diseases. However, few studies have examined the association of gestational diabetes with long-term mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the associations between gestational diabetes and long-term risks of total and cause-specific mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cohort study analyzed participants of the Nurses\u2019 Health Study II who were followed for 30 years (1989-2019). Participants included US female nurses aged 25 to 42 years who reported at least 1 pregnancy (\u22656 months) at 18 years or older across their reproductive life span. Data were analyzed from May 1, 2022, to May 25, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Gestational diabetes across the reproductive life span.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Hazard ratios (HRs with 95% CIs) for total and cause-specific mortality were estimated by Cox proportional hazards regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 91\u202f426 parous participants were included, with a mean (SD) age of 34.9 (4.7) years and a body mass index of 24.1 (4.7) at baseline. During a follow-up period of 2\u202f609\u202f753 person-years, 3937 deaths were documented, including 255 deaths from cardiovascular disease and 1397 from cancer. Participants with a history of gestational diabetes had a higher crude mortality rate than those without a history of gestational diabetes (1.74 vs 1.49 per 1000 person-years; absolute difference\u2009=\u20090.25 per 1000 person-years). The corresponding HR for total mortality was 1.28 (95% CI, 1.13-1.44), which did not materially change after additional adjustment for potential confounders and lifestyle factors during the reproductive life span (HR, 1.25; 95% CI, 1.11-1.41). The association persisted regardless of the subsequent development of type 2 diabetes and was more robust among participants who adopted less healthy lifestyles; experienced gestational diabetes in 2 or more pregnancies (HR, 1.48; 95% CI, 0.99-2.19); had gestational diabetes both in the initial and subsequent pregnancies (HR, 1.71; 95% CI, 1.11-2.63); and concurrently reported hypertensive disorders in pregnancy (HR, 1.80; 95% CI, 1.21-2.67), preterm birth (HR, 2.46; 95% CI, 1.66-3.64), or low birth weight (HR, 2.11; 95% CI, 1.21-3.68). Cause-specific mortality analyses revealed that gestational diabetes was directly associated with the risk of mortality due to cardiovascular disease (HR, 1.59; 95% CI, 1.03-2.47). Additionally, gestational diabetes was inversely associated with cancer mortality (HR, 0.76; 95% CI, 0.59-0.98); however, it was only evident among participants who later developed type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230060-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Results of this cohort study suggest that participants who reported a history of gestational diabetes exhibited a small but elevated risk of subsequent mortality over 30 years. The findings emphasize the importance of considering gestational diabetes as a critical factor in later-life mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.4401","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T11:01:04Z","timestamp":1694430064000},"page":"1204","source":"Crossref","is-referenced-by-count":60,"title":["Association of Gestational Diabetes With Subsequent Long-Term Risk of Mortality"],"prefix":"10.1001","volume":"183","author":[{"given":"Yi-Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China"},{"name":"Department of Nutrition, Harvard T.H. 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