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Katica Bajuk Studen Nuclear Medicine Department, University Medical Centre Ljubljana, Ljubljana, Slovenia

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Marija Pfeifer Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

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disorders in PCOS There is also a growing body of evidence suggesting that sleep disturbances including obstructive sleep apnea (OSA) and excessive daytime sleepiness can be added to the list of cardiometabolic risk factors in PCOS with link between the

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Siphiwe N Dlamini SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

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Zané Lombard Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Lisa K Micklesfield SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Nigel Crowther Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Shane A Norris SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Tracy Snyman Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Andrew A Crawford Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK

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Brian R Walker BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Institute of Genetic Medicine to Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

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Julia H Goedecke SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

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components, and related cardiometabolic risk factors, including measures of obesity, insulin resistance, and glucose intolerance ( 3 , 4 , 5 , 6 , 7 ). Cortisol may not be the only glucocorticoid involved in metabolic syndrome as humans also produce

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Line K Johnson Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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Kirsten B Holven Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway
Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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Njord Nordstrand Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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Jan R Mellembakken Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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Tom Tanbo Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway
Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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Jøran Hjelmesæth Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway
Morbid Obesity Centre, Department of Nutrition, Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Gynecology, Institute of Clinical Medicine, Department of Endocrinology, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway

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a lower prevalence of cardiometabolic risk factors including MS, cardiovascular inflammation and obesity (15) . Additionally, fiber intake improves gastrointestinal function and may prevent development of colorectal cancer (16) . Fiber intake from

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Angelo Maria Patti Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy

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Kalliopi Pafili Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece

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Nikolaos Papanas Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece

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Manfredi Rizzo Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy

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( 19 , 20 , 21 ), and family history of CV risk is closely related to future CVD ( 22 , 23 ). Is there a synergistic effect of GDM and HDP on postpartum cardiometabolic risk? It has been reported that there is a significant link between

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Yee-Ming M Cheung Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
Department of Endocrinology, Austin Health, Melbourne, Australia
Division of Endocrinology, Diabetes and Metabolism, Northwell, Great Neck, New York, USA

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Rudolf Hoermann Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia

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Karen Van Department of Endocrinology, Austin Health, Melbourne, Australia

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Damian Wu Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia

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Jenny Healy Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia

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Bella Halim Department of Endocrinology, Austin Health, Melbourne, Australia

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Manjri Raval Department of Endocrinology, Austin Health, Melbourne, Australia

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Maria McGill Department of Radiology, Austin Health, Melbourne, Australia

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Ali Al-Fiadh Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
Department of Cardiology, Austin Health, Melbourne Australia

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Michael Chao Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia

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Shane White Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia

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Belinda Yeo Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia
Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia

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Jeffrey D Zajac Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
Department of Endocrinology, Austin Health, Melbourne, Australia

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Mathis Grossmann Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Australia
Department of Endocrinology, Austin Health, Melbourne, Australia

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composition and various other cardiometabolic risk markers in postmenopausal women with early or locally advanced ER+ breast cancer ( 22 ). We demonstrated that in women initiating AI therapy after 12 months of treatment, the difference between AI and

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Ling-Jun Li Division of O&G, KK Women’s and Children’s Hospital, Singapore, Singapore
O&G ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

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Izzuddin M Aris Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore

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Lin Lin Su Department of O&G, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

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Yap Seng Chong Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
Department of O&G, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

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Tien Yin Wong O&G ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

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Kok Hian Tan Division of O&G, KK Women’s and Children’s Hospital, Singapore, Singapore
O&G ACP, Duke-NUS Graduate Medical School, Singapore, Singapore

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Jie Jin Wang O&G ACP, Duke-NUS Graduate Medical School, Singapore, Singapore

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Aims

The cumulative effect of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) on postpartum cardio-metabolic diseases is equivocal. We aimed to assess the associations of GDM and HDP’s individual and synergic contribution to risks of postpartum cardio-metabolic diseases (metabolic syndrome (MetS), abnormal glucose metabolism and hypertension (HTN)).

Methods

Of participants from a Singapore birth cohort, 276 mothers attending the 5-year postpartum visit were included in this study. During this visit, we collected mothers’ history of GDM and HDP in all live births in a chronicle sequence and assessed the cardio-metabolic risks based on blood pressure, anthropometry and a panel of serum biomarkers. We diagnosed MetS, abnormal glucose metabolism and HTN according to Adult Treatment Panel III 2000 and World Health Organization guidelines.

Results

Of 276 mothers, 157 (56.9%) had histories of GDM while 23 (8.3%) had histories of HDP. After full adjustment, we found associations of GDM episodes with postpartum abnormal glucose metabolism (single episode: relative risk (RR) 2.9 (95% CI: 1.7, 4.8); recurrent episodes (≥2): RR = 3.8 (2.1–6.8)). Also, we found association between histories of HDP and HTN (RR = 3.6 (1.5, 8.6)). Having either (RR 2.6 (1.7–3.9)) or both gestational complications (RR 2.7 (1.6–4.9)) was associated with similar risk of postpartum cardio-metabolic disease.

Conclusions

Mothers with GDM or HDP had a threefold increased risk of postpartum abnormal glucose metabolism or HTN, respectively. Having both GDM and HDP during past pregnancies was not associated with additional risk of postpartum cardio-metabolic diseases beyond that associated with either complication alone.

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David Koeckerling Medical Sciences Division, University of Oxford, Oxford, UK

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Jeremy W Tomlinson Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK

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Jeremy F Cobbold Oxford Liver Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK

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NASH had no significant bearing on outcomes ( 19 ). Unsurprisingly given the cardiometabolic risk factors inherent to the metabolic syndrome, cardiovascular disease is the most common cause of death in NAFLD ( 17 , 19 , 20 ). The intricate

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Aliyu Tijani Jibril Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

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Ahmad Jayedi Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

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Sakineh Shab-Bidar Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

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managing diabetic complications due to its antioxidant properties. However, studies evaluating the effect of ALA supplementation on cardiometabolic risk factors remain controversial. While some studies found a significant effect of supplementation of ALA on

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Valeria Hirschler University of Buenos Aires, Buenos Aires, Argentina

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Claudia Molinari University of Buenos Aires, Buenos Aires, Argentina

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Silvia Lapertosa UNNE, Corrientes, Argentina

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Gustavo Maccallini Hidalgo Laboratories, Buenos Aires, Argentina

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Claudio D Gonzalez CEMIC, Buenos Aires, Argentina

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Introduction The current definition of overweight/obesity (OW/OB) using BMI has been questioned by current studies in adults, suggesting that BMI might not be the best indicator of cardiometabolic risk ( 1 ). The present definition of

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Shenglong Le Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland

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Leiting Xu Medical School, Ningbo University, Ningbo, China

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Moritz Schumann Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
The Key Laboratory of Systems Biomedicine, Ministry of Education, and Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China

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Na Wu Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland

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Timo Törmäkangas Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland

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Markku Alén Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland

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Sulin Cheng Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
The Key Laboratory of Systems Biomedicine, Ministry of Education, and Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China

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Petri Wiklund Exercise, Health and Technology Centre, Department of Physical Education, Shanghai Jiao Tong University, Shanghai, China
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
Department of Epidemiology and Biostatistics, Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland

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might be an important regulator of puberty and a biomarker for cardiometabolic risk ( 3 ). However, confounding or reverse causation, may explain part of the association. Indeed, there may be a bidirectional relationship between SHBG, insulin resistance

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