ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1641103
This article is part of the Research TopicPostpartum BMI and Cardiovascular-Kidney Metabolic Syndrome: Navigating Weight Management Post-GDMView all articles
Longitudinal Patterns of Postpartum Body Mass Index and Their Impact on Cardiometabolic and Renal Risk Among Women with Prior Gestational Diabetes: A Prospective Cohort Analysis
Provisionally accepted
- 1Northern Theater Command General Hospital, Shenyang, China
- 2The First Hospital of China Medical University Department of Orthopedics, Shenyang, China
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Background: Women with a history of gestational diabetes mellitus (GDM) face a heightened long-term risk of developing interconnected cardiovascular, renal, and metabolic (CKM) conditions. Although postpartum weight management presents a critical opportunity for intervention, the behavioral and psychosocial pathways linking body mass index (BMI) trajectories after childbirth to CKM progression remain poorly defined.Methods: This prospective cohort study followed 1,268 women with prior GDM, enrolled within six months after delivery and tracked over a median period of 6.5 years. Latent class growth modeling was employed to identify distinct patterns of postpartum BMI change. Psychosocial stress and sleep quality were assessed using standardized instruments at baseline and at the three-year follow-up. Incident CKM outcomes-including hypertension, type 2 diabetes mellitus (T2DM), and reduced estimated glomerular filtration rate (eGFR)-were verified through clinical records.Multivariable Cox regression was used to evaluate the relationship between BMI trajectories and CKM risk, while parallel mediation models quantified the indirect contributions of stress and sleep disturbances.Results: Participants with persistently high or progressively increasing BMI patterns experienced significantly elevated risks of CKM outcomes (hazard ratios ranging from 1.35 to 2.10, all p < 0.01), compared to those with stable or declining BMI.Mediation analysis revealed that psychosocial stress and impaired sleep jointly mediated 12.3% (95% CI: 0.02-0.09 for stress; 0.00-0.07 for sleep) of the association in the gradual increase group and 18.5% (95% CI: 0.04-0.13 for stress; 0.02-0.09 for sleep) in the persistently high group, indicating statistically significant indirect effects.In women with a history of GDM, adverse postpartum BMI trajectories are strongly associated with increased long-term risk of CKM morbidity, with behavioral factors such as stress and sleep quality serving as partial mediators.
Keywords: body mass index trajectories1, gestational diabetes history2, cardiometabolic and renal outcomes3, psychosocial stressors4, sleep quality disruption5, behavioral mediation modeling6
Received: 04 Jun 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Nie, Zhao and Jing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zicheng Nie, Northern Theater Command General Hospital, Shenyang, China
Quanmin Jing, Northern Theater Command General Hospital, Shenyang, China
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