Healthy habits cut heart disease risk by 86% in women with gestational diabetes

A landmark study led by researchers from the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), and Harvard T.H. Chan School of Public Health found that women with a history of gestational diabetes mellitus (GDM) can slash their risk of future cardiovascular disease (CVD) considerably through sustained healthy lifestyle habits.

Modifiable habits make a lifesaving difference

GDM—a condition characterized by elevated blood sugar during pregnancy—remains one of the most common pregnancy complications worldwide.

The new study, published in the Journal of the American Heart Association (JAHA), tracked over 4,300 women from the long-running Nurses’ Health Study II cohort, all of whom had a history of GDM but were free of heart disease and diabetes at the outset.

The research found that women who adopted a long-term commitment to a combination of five healthy lifestyle behaviors—maintaining a healthy weight, not smoking, regular physical activity, eating a high-quality diet, and moderate alcohol intake—reduced their risk of developing CVD by up to 86% compared to those who did not adopt any of these habits.

Remarkably, among women who consistently followed all five optimal lifestyle factors, no cardiovascular events were observed over nearly 28 years of follow-up.

“Our findings suggest that CVD is not an inevitable outcome for women with a history of gestational diabetes,” said Dr. Yang Jiaxi, Senior Research Fellow at the Global Center for Asian Women’s Health (GloW), NUS Medicine, and co-first author of the study. “Even modest lifestyle improvements after pregnancy can significantly reduce future heart risk.”

In fact, the study underscored the importance of improving lifestyle habits over time as these changes were associated with substantially reduced CVD risk, while declines in these habits increased risk substantially.

Co-first author, Dr. Frank Qian, who was a Master of Public Health student working in the Department of Nutrition at Harvard T.H. Chan School of Public Health at the time of the research, said, “As a cardiologist and public health practitioner, these findings are really a wake-up call on the importance of counseling and promoting an environment where women with a history of GDM can adopt the behavioral changes that can stave off cardiovascular complications.

“We’re really talking about the opportunity to prevent or delay a large number of mostly premature cardiovascular events.”

Dr. Frank Qian is currently a Cardiovascular Disease Fellow at Boston Medical Center and a Clinical Instructor at the Boston University Chobanian & Avedisian School of Medicine.

Turning the tide against heart disease in Singapore and Asia

In Singapore, CVD accounted for 30.9% of all deaths in 2023—nearly one in three deaths in Singapore is due to heart disease or stroke. With Asian women facing some of the world’s highest risks for developing GDM and with GDM nearly doubling the risk of subsequent CVD, these findings spotlight the potential for targeted lifestyle interventions as a powerful tool for reducing CVD risk and support long-term prevention efforts.

Early, sustained efforts to promote healthy weight, diet, and physical activity starting in the reproductive years can yield long-lasting benefits for women’s heart health. The research team stressed the urgent need for increased public health efforts and clinical guidelines targeting women after GDM and hope that these findings can spur future studies to identify the most effective prevention strategies at both the clinical and population levels.

“These findings once again underscore the importance of continued follow-up for women who experience high blood sugar in pregnancy,” said Professor Zhang Cuilin, Chair Professor in Women’s Health at the NUS Medicine Department of Obstetrics and Gynecology and Director of GloW at NUS Medicine and senior author of the study.

“Supporting them in adopting healthy dietary and lifestyle habits is crucial to safeguarding their long-term cardiometabolic health and overall well-being. These women face a higher risk of developing other chronic conditions, making early intervention all the more vital. We are investigating sustainable intervention approaches and underlying molecular mechanisms in our ongoing studies.”