Which of the following is a high-risk factor for diabetes in pregnancy?

A history of cardiovascular disease is considered a high-risk factor for diabetes in pregnancy due to its association with systemic inflammation, endothelial dysfunction, and possible insulin resistance. Women with pre-existing cardiovascular conditions may have altered metabolism, which can predispose them to gestational diabetes. This connection underscores the importance of monitoring such high-risk individuals more closely during pregnancy to identify and manage diabetes early, thereby reducing potential complications for both the mother and the baby.

While heavy smoking, recent weight gain, and multiple pregnancies may contribute to diabetes risk, they do not carry the same direct correlation to the pathophysiological mechanisms of diabetes during pregnancy as cardiovascular disease does. Heavy smoking has its own set of risks related to pregnancy outcomes, but its relation to diabetes is not as robust. Recent weight gain can be significant, particularly if it leads to obesity, but it is a more indirect risk factor. Multiple pregnancies are associated with other complications but do not inherently increase the risk of developing diabetes to the same extent as a history of cardiovascular disease.