We thank Fan et al.¹ for their interest in and support for our work on pre-eclampsia, gestational diabetes mellitus (GDM) and risk for later cardiovascular disease.² We agree that hypertension may be a mediator of CVD and look forward to further research in this area.

We have reflected on the suggestion that excluding women with pre-existing diabetes before pregnancy is a disadvantage and could lead to bias. We would like to clarify that the aim of the study was to look specifically at the risk of cardiovascular disease in relation to GDM. We could have included pre-existing diabetes in the analyses but in that case the risk for CVD could not be established for GDM only. Women with type 2 diabetes in pregnancy were initially coded together with women with type 1 diabetes (and hence could not be disentangled from the ‘pre-existing diabetes’ coding), and were uncommon during this study period, making any bias very small. We agree that studies on pre-existing type 1 diabetes regarding CVD risk are needed, but should be performed separately in view of its very different aetiological mechanisms.

We agree with Fan et al. that studies on the prevention of CVD in women at high risk are needed, and hope that our work helps stimulate such research as a matter of urgency.

我们感谢范等人。¹感谢他们对我们在先兆子痫、妊娠糖尿病 (GDM) 和后期心血管疾病风险方面的工作的兴趣和支持。²我们同意高血压可能是 CVD 的介质，并期待该领域的进一步研究。

我们已经反思了这样的建议：将怀孕前患有糖尿病的女性排除在外是一种劣势，并且可能会导致偏见。我们想澄清的是，该研究的目的是专门研究与 GDM 相关的心血管疾病风险。我们本可以将已有的糖尿病纳入分析中，但在这种情况下，无法仅针对 GDM 确定 CVD 风险。妊娠期患有 2 型糖尿病的女性最初与患有 1 型糖尿病的女性一起编码（因此无法与“既往糖尿病”编码分开），并且在本研究期间并不常见，因此任何偏差都非常小。我们同意，需要对已存在的 1 型糖尿病进行有关 CVD 风险的研究，但鉴于其病因机制截然不同，应单独进行。

我们同意 Fan 等人的观点。需要对高危女性预防 CVD 进行研究，并希望我们的工作有助于推动此类研究成为当务之急。