IDF21-0485 Hyperglycaemia in pregnancy is associated with cardiovascular and renal risk among Aboriginal women in Australia

Background: Around the world, First Nations peoples in countries with similar histories of colonisation experience substantial health and socioeconomic disparities. Aboriginal people in the Northern Territory (NT) of Australia have a high burden of type 2 diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD). Rates of hyperglycaemia in pregnancy, including both gestational diabetes (GDM) and pre-existing diabetes, are increasing. Internationally, GDM has been associated with future CVD, but the relationship with CKD is less clear. Pregnancy may be a valuable opportunity to evaluate and manage future cardiometabolic risk given routine diabetes screening and near universal healthcare engagement. Aim: To investigate CVD and CKD risk among Aboriginal women with GDM and pre-existing diabetes compared to those without known diabetes during pregnancy. Method: A retrospective, longitudinal cohort study was performed among Aboriginal women who gave birth from 2000 to 2016, using linked data from the NT Perinatal Data Collection and NT Hospital Inpatient Activity dataset (2000–2018). Pre-specified outcomes included hospital admissions for a composite CVD endpoint (ischaemic heart disease, stroke or peripheral vascular disease), heart failure, CKD (any stage) and end stage kidney disease (ESKD). Time-to-event analyses were undertaken using Cox proportional hazards regression (Table). Results: The cohort included 10,931 Aboriginal women. At the index pregnancy, mean age was 23.1 (SD 6.2) years, 755 (6.9%) had GDM and 241 (2.2%) had pre-existing diabetes. Median follow-up was 12.1 (IQR 7.2–15.8) years. Compared to those without diabetes, women with GDM or pre-existing diabetes had increased risk for CVD, heart failure, CKD and ESKD.Tabled 1OutcomeEvent rates, n(%)HR (95% CI)* vs. no known diabetes during pregnancyNo known diabetesGDMPre-existing diabetesGDMPre-existing diabetesCVD242 (2.4)49 (6.5)34 (14)2.7 (1.9-3.8)3.4 (2.1-5.3)Heart failure174 (1.8)25 (3.3)19 (7.9)2.7 (1.6-4.4)5.3 (2.9-9.6)CKD250 (2.5)74 (9.8)89 (37)5.1 (3.8-6.8)14 (9.6-19)ESKD50 (0.5)21 (2.8)29 (12)10 (5.5-20)34 (17-68) Open table in a new tab *Adjusted for age, hypertensive disorder, parity, remoteness and smoking during index pregnancy. Discussion: In this relatively young cohort of Aboriginal women in Australia, GDM and pre-existing diabetes in pregnancy were strongly associated with development of cardiovascular and kidney disease. Culturally appropriate post-partum strategies to reduce cardiometabolic risk should be investigated along with public health strategies that address the social determinants of health.