Hypertension at 5 months postpartum in women with gestational diabetes

ABSTRACT Objective Gestational diabetes mellitus (GDM) is associated with future maternal cardiovascular disease, independent of the development of Type‐2 diabetes mellitus. As a major cardiovascular risk factor, we examined the incidence and predictors of hypertension at 5 months postpartum in women with previous GDM. Methods Between September 2023 and January 2025, we conducted a single‐center observational prospective cohort study of all women who received routine prenatal care at 12 weeks' gestation at King's College Hospital, London, UK, and developed GDM during the index pregnancy. Those with chronic hypertension were excluded from the analysis. Women were invited to a 5‐month postpartum visit, at which assessment was undertaken for hypertension (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg, or receiving antihypertensive treatment), obesity, adiposity, dysglycemia, dyslipidemia and renal dysfunction. Logistic regression was performed to assess predictors of postnatal hypertension. Results Among the 678 included women with previous GDM in the index pregnancy, 179 (26.4%) developed hypertension at a median of 5.1 (interquartile range (IQR), 4.4–6.7) months postpartum. Multivariable analysis showed that postpartum hypertension was associated with: higher maternal age, Black or mixed ethnicity, higher median weight in early pregnancy, higher systolic and diastolic blood pressure in early pregnancy, and development of pre‐eclampsia (PE) or gestational hypertension (GH) in the index pregnancy. The area under the receiver‐operating‐characteristics curve for the prediction of postpartum hypertension was 0.72 (95% CI, 0.68–0.77) without inclusion of development of PE or GH, and 0.74 (95% CI, 0.70–0.78) with their inclusion. The corresponding detection rates for postpartum hypertension were 49.5% and 53.7%, respectively, at a 20% false‐positive rate. Notably, women with GDM in the index pregnancy frequently had dysglycemia (351/678 (51.8%)) as well as body mass index ≥ 30 kg/m 2 (232/678 (34.2%)), waist‐to‐height ratio > 0.5 (502/678 (74.0%)), dyslipidemia (186/678 (27.4%)) and/or renal dysfunction (78/678 (11.5%)). At the 5‐month postpartum review, among women with previous GDM who developed postpartum hypertension compared to those who were normotensive at follow‐up, median BMI was significantly higher (30.1 (IQR, 26.7–36.8) vs 27.0 (IQR, 23.5–30.6) kg/m 2 ), a waist‐to‐height ratio > 0.5 was significantly more prevalent (87.7% vs 69.1%) and dyslipidemia was significantly more common (35.8% vs 24.4%). Conclusion One in four women with recent GDM developed hypertension at 5 months postpartum. However, risk prediction from factors observed in early pregnancy was only modest, reinforcing the need for universal postpartum BP assessment. The high prevalence of hypertension and other cardio‐renal‐metabolic abnormalities following GDM emphasizes the associated enhanced cardiovascular risk, and the postnatal opportunities for intervention early in the life course of these women. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.