Combined lifestyle and type 2 diabetes mellitus among women with a history of GDM or HDP

Aim: We explored whether adherence to a combined healthy lifestyle was associated with the long-term risk of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP) and whether genetic susceptibility modified this association.

Methods: A total of 3,109 women aged 40-69 years with a history of GDM and HDP were included in the present study. All participants were selected from the UK Biobank. We constructed a combined lifestyle score based on six favorable lifestyle factors, including diet, smoking, alcohol consumption, physical activity, sleep, and body mass index (BMI). Scores ranged from 0 to 6, with higher scores reflecting a healthier lifestyle. We applied the Cox proportional hazard regression to evaluate the association between the combined lifestyle score and the risk of T2DM. We further examined the interplay of the polygenic risk score (PRS) with the combined lifestyle regarding the development of T2DM.

Results: Compared with those scoring 0 points, participants with combined lifestyle scores of 2, 3, and ≥ 4 points had significantly lower risks of T2DM, with hazard ratios (95% confidence intervals) of 0.54 (0.32, 0.93), 0.37 (0.22, 0.64), and 0.29 (0.16, 0.53), respectively. A significant dose-response relationship was noted (P for trend < 0.001). However, there was no interaction between the PRS and combined lifestyle score for the risk of T2DM (P for interaction = 0.247).

Conclusions: For those with a history of GDM or HDP, a healthier combined lifestyle was linked to a dose-dependent decrease in T2DM risk. These inverse associations were consistent across strata of genetic susceptibility and other major participant characteristics.