Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication and has been linked to adverse cardiometabolic outcomes later in life. However, evidence on its association with multimorbidity patterns in southwest of Iran remains limited.

Methods: This population-based cross-sectional analysis was conducted using baseline data from the Hoveyzeh Cohort Study (2016-2018) in southwest Iran. Women aged 35-70 years with at least one prior pregnancy were included. History of GDM was ascertained by self-report. Cardiometabolic burden was summarized using a Cardiometabolic Burden Score (CMBS) based on the presence of type 2 diabetes, hypertension, and cardiovascular disease. Ordinal logistic regression was used to examine the association between prior GDM and CMBS.

Results: Among 5477 women, 221 (4.0%) reported a history of GDM. In unadjusted analysis, prior GDM was not significantly associated with CMBS. After adjustment for age, body mass index, education, smoking, and physical activity, women with a history of GDM had higher odds of greater cardiometabolic burden (adjusted OR 2.05; 95% CI 1.57-2.67). Older age, obesity, pregnancy hypertension, and elevated triglycerides were also associated with higher CMBS, whereas higher physical activity and higher educational level were associated with lower burden. Among 5477 women, 221 (4.0%) reported a history of GDM. Prior GDM was not significantly associated with CMBS in unadjusted analysis. After adjustment for age, body mass index, education, smoking, and physical activity, women with a history of GDM had higher odds of greater cardiometabolic burden (adjusted OR 2.05; 95% CI 1.57-2.67). Older age, obesity, pregnancy hypertension, and elevated triglycerides were also associated with higher CMBS, whereas higher physical activity and higher educational level were associated with lower burden.

Conclusions: In this cross-sectional population-based study, a history of GDM was associated with a greater current cardiometabolic burden. These findings support GDM as a marker of later-life cardiometabolic vulnerability and underscore the importance of long-term follow-up and preventive care after pregnancy.