{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:50:50Z","timestamp":1786373450761,"version":"build-2736575974"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"crossref","award":["UK Charity No: 1037116"],"award-info":[{"award-number":["UK Charity No: 1037116"]}],"id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,10]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Kidney dysfunction was diagnosed at 5 months postpartum in 12% of women who had gestational diabetes mellitus.<\/jats:p>\n <\/jats:list-item>\n \n Three quarters of women (616; 75%) had at least one cardiometabolic risk factor.<\/jats:p>\n <\/jats:list-item>\n \n Postpartum diagnosis offers an opportunity for early intervention to reduce progression of kidney disease, including those from marginalized groups.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Gestational diabetes mellitus (GDM) is associated with future maternal type 2 diabetes mellitus and cardiovascular phenotypes including CKD. We aimed to explore if features of CKD and associated cardiovascular disease risk factors were already present postpartum in women with GDM and if postpartum clinics could provide an early opportunity to reduce burden of disease in marginalized groups.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n All women who had routine antenatal care at a tertiary maternity unit in the United Kingdom and developed GDM were invited to attend a 5-month postnatal visit between September 2023 and January 2025. Maternal demographic characteristics, medical history, and pregnancy outcome were recorded, and kidney dysfunction, dysglycemia, hypertension, adiposity, and dyslipidemia were assessed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 817 (77%) of the 1064 eligible women attended the clinic. Women were more likely to attend if they were of Black race, had chronic hypertension, family history of diabetes mellitus, or required insulin and\/or metformin as treatment for GDM control. Ninety-eight (12%) women had kidney dysfunction (urine albumin-creatinine ratio \u22653 mg\/mmol [26.55 mg\/g]): 97 (99%; eGFR <60 ml\/min per 1.73 m\n 2<\/jats:sup>\n :1 (1%), but only 9 (9%) women with kidney dysfunction met diagnostic criteria for type 2 diabetes. There were 616 (75%) women with one or more cardiometabolic risk factors (kidney dysfunction, dyslipidemia, dysglycaemia, and\/or hypertension) and 279 (34%), 84 (10%), and 13 (2%) with at least two, three, or four risk factors, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A high prevalence of microalbuminuria was identified in women who had previous GDM at 5 months after delivery, and the majority did not meet criteria for type 2 diabetes, but three quarters had cardiovascular risk factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000802","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T16:00:30Z","timestamp":1755619230000},"page":"1418-1426","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Kidney Dysfunction Following Gestational Diabetes Mellitus"],"prefix":"10.2215","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4417-9838","authenticated-orcid":false,"given":"Mair\u00e9ad","family":"Hamill","sequence":"first","affiliation":[{"name":"School of Life Course and Population Sciences, King's College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9359-997X","authenticated-orcid":false,"given":"Cristina","family":"Gomez Fernandez","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom"},{"name":"Faculty of Medicine, Complutense University of Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rea","family":"Mitsigiorgi","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2670-0396","authenticated-orcid":false,"given":"Tanvi","family":"Mansukhani","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kypros H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Bramham","sequence":"additional","affiliation":[{"name":"School of Life Course and Population Sciences, King's College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"B1-20260520","doi-asserted-by":"crossref","first-page":"m1361","DOI":"10.1136\/bmj.m1361","article-title":"Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis","volume":"369","author":"Vounzoulaki","year":"2020","journal-title":"BMJ."},{"issue":"8","key":"B2-20260520","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1161\/CIRCULATIONAHA.118.036748","article-title":"Cardiovascular disease related morbidity and mortality in women with a history of pregnancy complications: systematic review and meta-analysis","volume":"139","author":"Grandi","year":"2019","journal-title":"Circulation."},{"issue":"3","key":"B3-20260520","doi-asserted-by":"crossref","first-page":"e0264992","DOI":"10.1371\/journal.pone.0264992","article-title":"Does gestational diabetes increase the risk of maternal kidney disease? A Swedish national cohort study","volume":"17","author":"Barrett","year":"2022","journal-title":"PLoS One."},{"issue":"4","key":"B4-20260520","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1210\/jc.2014-4474","article-title":"Gestational diabetes mellitus is a significant risk factor for long-term maternal renal disease","volume":"100","author":"Beharier","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"issue":"11","key":"B5-20260520","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1093\/ndt\/gfz174","article-title":"A single number for advocacy and Communication\u2014Worldwide more than 850 million individuals have kidney diseases","volume":"34","author":"Jager","year":"2019","journal-title":"Nephrol Dial Transplant."},{"issue":"10225","key":"B6-20260520","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"395","year":"2020","journal-title":"Lancet."},{"issue":"8","key":"B7-20260520","doi-asserted-by":"crossref","first-page":"100851","DOI":"10.1016\/j.xkme.2024.100851","article-title":"SGLT2 inhibitor use in chronic kidney disease: supporting cardiovascular, kidney, and metabolic health","volume":"6","author":"Madero","year":"2024","journal-title":"Kidney Med."},{"issue":"1","key":"B8-20260520","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.kint.2020.10.012","article-title":"The case for early identification and intervention of chronic kidney disease: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference","volume":"99","author":"Shlipak","year":"2021","journal-title":"Kidney Int."},{"issue":"12","key":"B9-20260520","doi-asserted-by":"crossref","first-page":"2586","DOI":"10.2337\/dc10-1095","article-title":"Gestational diabetes mellitus alone in the absence of subsequent diabetes is associated with microalbuminuria: results from the Kidney Early Evaluation Program (KEEP)","volume":"33","author":"Bomback","year":"2010","journal-title":"Diabetes Care."},{"issue":"2","key":"B10-20260520","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1001\/jamacardio.2019.4867","article-title":"Association of longitudinal trajectory of albuminuria in young adulthood with myocardial structure and function in later life: coronary artery risk development in young adults (CARDIA) study","volume":"5","author":"Patel","year":"2020","journal-title":"JAMA Cardiol."},{"issue":"2","key":"B11-20260520","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1001\/jama.2015.18202","article-title":"Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis","volume":"315","author":"Tangri","year":"2016","journal-title":"JAMA."},{"issue":"5","key":"B12-20260520","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s00125-023-05868-w","article-title":"Risk of kidney disease following a pregnancy complicated by diabetes: a longitudinal, population-based data-linkage study among aboriginal women in the northern territory, Australia","volume":"66","author":"Hare","year":"2023","journal-title":"Diabetologia."},{"issue":"7","key":"B13-20260520","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.2337\/dc17-2629","article-title":"Gestational diabetes mellitus and renal function: a prospective study with 9- to 16-year follow-up after pregnancy","volume":"41","author":"Rawal","year":"2018","journal-title":"Diabetes Care."},{"issue":"3","key":"B14-20260520","doi-asserted-by":"crossref","first-page":"401","DOI":"10.2337\/dc23-1092","article-title":"Kidney disease in women with previous gestational diabetes mellitus: a nationwide register-based cohort study","volume":"47","author":"Christensen","year":"2024","journal-title":"Diabetes Care."},{"issue":"2","key":"B15-20260520","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1161\/HYPERTENSIONAHA.120.17101","article-title":"Short-term postpartum blood pressure self-management and long-term blood pressure control: a randomized controlled trial","volume":"78","author":"Kitt","year":"2021","journal-title":"Hypertension."},{"issue":"6","key":"B16-20260520","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1161\/HYPERTENSIONAHA.120.15875","article-title":"Postnatal enalapril to improve cardiovascular function following preterm preeclampsia (PICk-UP): a randomized double-blind placebo-controlled feasibility trial","volume":"76","author":"Ormesher","year":"2020","journal-title":"Hypertension."},{"issue":"9","key":"B18-20260520","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Internal Med."},{"issue":"suppl 1","key":"B19-20260520","first-page":"S17","article-title":"2. Classification and diagnosis of diabetes: standards of medical care in Diabetes-2022","volume":"45","year":"2022","journal-title":"Diabetes Care."},{"issue":"6","key":"B21-20260520","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1161\/HYP.0000000000000066","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American college of cardiology\/American Heart Association task force on clinical practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension."},{"issue":"4","key":"B22-20260520","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S2213-8587(23)00058-X","article-title":"Lancet diabetes & Endocrinology Commission on the definition and diagnosis of clinical obesity","volume":"11","author":"Rubino","year":"2023","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B23-20260520","first-page":"1","article-title":"ACOG Practice Bulletin No. 202. Gestational Hypertension and Preeclampsia","volume":"133","year":"2019","journal-title":"Obstet Gynecol."},{"issue":"1","key":"B24-20260520","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/AOG.0000000000003020","article-title":"ACOG practice bulletin no. 203: chronic hypertension in pregnancy","volume":"133","year":"2019","journal-title":"Obstet Gynecol."},{"issue":"1","key":"B25-20260520","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/uog.19073","article-title":"Fetal Medicine Foundation fetal and neonatal population weight charts","volume":"52","author":"Nicolaides","year":"2018","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B27-20260520","first-page":"1","article-title":"KDIGO CKD Work Group KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","year":"2013","journal-title":"Kidney Int Suppl."},{"issue":"1","key":"B28-20260520","doi-asserted-by":"crossref","first-page":"101","DOI":"10.2337\/dc16-1400","article-title":"Role of type 2 diabetes in determining retinal, renal, and cardiovascular outcomes in women with previous gestational diabetes mellitus","volume":"40","author":"Retnakaran","year":"2017","journal-title":"Diabetes Care."},{"issue":"9","key":"B29-20260520","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.mpmed.2019.06.010","article-title":"Epidemiology and causes of chronic kidney disease","volume":"47","author":"Noble","year":"2019","journal-title":"Medicine."},{"issue":"1","key":"B30-20260520","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12882-016-0303-x","article-title":"Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults","volume":"17","author":"Seliger","year":"2016","journal-title":"BMC Nephrol."},{"issue":"1","key":"B31-20260520","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4093\/dmj.2011.35.1.1","article-title":"Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes","volume":"35","author":"Jang","year":"2011","journal-title":"Diabetes Metab J."},{"issue":"4","key":"B32-20260520","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1067\/mob.2002.121895","article-title":"Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus","volume":"186","author":"Schaefer-Graf","year":"2002","journal-title":"Am J Obstet Gynecol."},{"issue":"9","key":"B33-20260520","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/S0026-0495(98)90290-6","article-title":"Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study","volume":"47","author":"Mills","year":"1998","journal-title":"Metabolism."},{"key":"B34-20260520","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.diabres.2019.03.030","article-title":"High risk of metabolic syndrome after delivery in pregnancies complicated by gestational diabetes","volume":"150","author":"Shen","year":"2019","journal-title":"Diabetes Res Clin Pract."},{"issue":"5","key":"B35-20260520","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1053\/j.ajkd.2012.06.017","article-title":"Albuminuria, estimated GFR, traditional risk factors, and incident cardiovascular disease: the PREVEND (Prevention of Renal and Vascular Endstage Disease) Study","volume":"60","author":"Smink","year":"2012","journal-title":"Am J Kidney Dis."},{"issue":"17","key":"B36-20260520","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1093\/eurjpc\/zwae189","article-title":"The relationship between low levels of albuminuria and mortality among adults without major cardiovascular risk factors","volume":"31","author":"Claudel","year":"2024","journal-title":"Eur J Prev Cardiol."},{"issue":"2","key":"B37-20260520","doi-asserted-by":"crossref","first-page":"e1920964","DOI":"10.1001\/jamanetworkopen.2019.20964","article-title":"Adverse pregnancy outcomes and long-term maternal kidney disease: a systematic review and meta-analysis","volume":"3","author":"Barrett","year":"2020","journal-title":"JAMA Netw Open."},{"issue":"3","key":"B38-20260520","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1136\/jech.50.3.334","article-title":"The need and demand for renal replacement therapy in ethnic minorities in England","volume":"50","author":"Roderick","year":"1996","journal-title":"J Epidemiol Community Health."},{"issue":"4","key":"B39-20260520","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.ekir.2022.01.1054","article-title":"Genetic variants of APOL1 are major determinants of kidney failure in people of African ancestry with HIV","volume":"7","author":"Hung","year":"2022","journal-title":"Kidney Int Rep."},{"issue":"3","key":"B41-20260520","doi-asserted-by":"crossref","first-page":"e0299401","DOI":"10.1371\/journal.pone.0299401","article-title":"Cost-effectiveness of screening for chronic kidney disease using a cumulative eGFR-based statistic","volume":"19","author":"Zafarnejad","year":"2024","journal-title":"PLoS One."},{"issue":"12","key":"B42-20260520","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJMoa011161","article-title":"Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy","volume":"345","author":"Brenner","year":"2001","journal-title":"N Engl J Med."},{"issue":"12","key":"B43-20260520","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1056\/NEJMoa011303","article-title":"Renoprotective effect of the angiotensin-receptor antagonist Irbesartan in patients with nephropathy due to type 2 diabetes","volume":"345","author":"Lewis","year":"2001","journal-title":"N Engl J Med."},{"issue":"7","key":"B44-20260520","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1093\/ckj\/sfab070","article-title":"Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney","volume":"14","author":"Vanholder","year":"2021","journal-title":"Clin Kidney J."},{"issue":"12","key":"B45-20260520","doi-asserted-by":"crossref","first-page":"2832","DOI":"10.1681\/ASN.V12122832","article-title":"ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy","volume":"12","author":"Ruggenenti","year":"2001","journal-title":"J Am Soc Nephrol."},{"issue":"19","key":"B46-20260520","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1001\/jama.288.19.2421","article-title":"Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease:lresults from the AASK trial","volume":"288","author":"Wright","year":"2002","journal-title":"JAMA."},{"issue":"10","key":"B47-20260520","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/S2213-8587(16)30156-5","article-title":"Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials","volume":"4","author":"Herrington","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"3","key":"B48-20260520","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.ekir.2021.12.014","article-title":"History of Preeclampsia in patients undergoing a kidney biopsy: a biphasic, multiple-hit pathogenic hypothesis","volume":"7","author":"Cabiddu","year":"2022","journal-title":"Kidney Int Rep."},{"issue":"1","key":"B49-20260520","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1053\/j.ajkd.2014.11.019","article-title":"Kidney disease and maternal and fetal outcomes in pregnancy","volume":"66","author":"Kendrick","year":"2015","journal-title":"Am J Kidney Dis."},{"issue":"12","key":"B50-20260520","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1001\/jama.2021.14781","article-title":"Aspirin use to prevent preeclampsia and related morbidity and mortality: US preventive services task force recommendation statement","volume":"326","author":"Davidson","year":"2021","journal-title":"JAMA."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000802","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:45:57Z","timestamp":1786369557000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":46,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000802","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"assertion":[{"value":"2025-03-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}