BMC Med. 2026 Jul 3. doi: 10.1186/s12916-026-05033-1. Online ahead of print.
ABSTRACT
BACKGROUND: Gestational diabetes mellitus (GDM) is a well-established risk factor for subsequent type 2 diabetes mellitus (T2DM). However, its long-term association with diabetic microvascular complications, particularly diabetic retinopathy (DR), and the joint role of polycystic ovary syndrome (PCOS) remain incompletely understood.
METHODS: Using the Korean National Health Insurance Service database, we conducted a nationwide retrospective cohort study including 406,309 women who had their index delivery between 2005 and 2012. Standard Cox proportional hazards models were used to evaluate the incidence of T2DM and systemic complications. For DR and vision-threatening DR (VTDR), time-varying covariate Cox models were applied in the full cohort, with incident T2DM treated as a time-dependent variable. Sensitivity analyses restricted to women who developed T2DM were also performed. Stratified analyses evaluated the joint and independent effects of coexisting PCOS.
RESULTS: During follow-up, women with prior GDM had a higher risk of developing T2DM (adjusted hazard ratio [aHR] 3.52; 95% CI 3.26-3.80). In time-varying analyses, prior GDM was associated with an increased risk of vision-threatening DR (VTDR) (aHR 2.28; 95% CI 1.06-4.92), whereas overall DR did not show a consistent positive association across analysis. Women with both GDM and PCOS had the highest risk of T2DM and VTDR compared with those with neither condition (aHR 4.96 and 31.90, respectively). In contrast, although some macrovascular outcomes showed statistically significant associations, the overall magnitude of risk increase was modest.
CONCLUSIONS: A history of GDM was associated with an increased long-term risk of severe diabetic retinal outcomes, particularly VTDR, after the onset of T2DM. The coexistence of PCOS is associated with a higher overall risk burden, with women having both conditions showing the highest risks. These findings support the need for individualized metabolic and ophthalmic surveillance in women with prior GDM, particularly those with coexisting PCOS.
PMID:42399945 | DOI:10.1186/s12916-026-05033-1
