期刊
FRONTIERS IN ENDOCRINOLOGY
卷 13, 期 -, 页码 -出版社
FRONTIERS MEDIA SA
DOI: 10.3389/fendo.2022.1012244
关键词
gestational diabetes mellitus; type 2 diabetes mellitus; IADPSG criteria; systematic review; meta-analysis
资金
- Youth Program of National Natural Science Foundation of China
- National High Level Hospital Clinical Research Funding (Star of Outlook Scientific Research Project of Peking University First Hospital)
- National Key Research and Development Program of China
- [(82003528)]
- [(22cz020301-4803014)]
- [(2021YFC2700700)]
A systematic review and meta-analysis found that women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria have a higher risk of developing type 2 diabetes mellitus (T2DM) and prediabetes. The risk of T2DM in GDM women increases with longer follow-up duration.
BackgroundTo estimate the progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria.MethodsSystematic review and meta-analysis were conducted by searching Medline, Embase, and Cochrane between January 1, 2010 and December 31, 2021 for observational studies investigating progression to T2DM after GDM. Inclusion criteria were IADPSG-diagnosed GDM, studies with both GDM and controls, postpartum follow-up duration at least one year. Data were pooled by random effects meta-analysis models. Heterogeneity was assessed by I-2 statistic. The pooled relative risk for incidence of T2DM and pre-diabetes between GDM participants and controls were estimated. Reasons for heterogeneity among studies were investigated by prespecified subgroup and meta-regression analysis. Publication bias was assessed by the Begg's and Egger's tests.ResultsThis meta-analysis of six studies assessed a total of 61932 individuals (21978 women with GDM and 39954 controls). Women with IADPSG-diagnosed GDM were 6.43 times (RR=6.43, 95% CI:3.45-11.96) more likely to develop T2DM in the future compared with controls. For GDM women, the cumulative incidence of T2DM was 12.1% (95% CI: 6.9%-17.3%), while the pooled cumulative incidence of T2DM was estimated to be 8% (95% CI: 5-11%) in studies with 1 to 5 years of follow-up and increased to 19% (95% CI: 3-34%) for studies with more than 5 years of follow-up. Women with IADPSG-diagnosed GDM had 3.69 times (RR=3.69, 95% CI:2.70-5.06) higher risk of developing pre-diabetes (including impaired fasting glucose and/or impaired glucose tolerance) than controls. Meta-regression analysis showed that the study effect size was not significantly associated with study design, race, length of follow-up, and maternal age (P > 0.05). Overall, the studies had a relatively low risk of bias.ConclusionsWomen with IADPSG-diagnosed GDM have higher risk of developing T2DM and pre-diabetes. The risk of T2DM in GDM women are higher with longer follow-up duration. Our results highlight the importance of promoting postpartum screening and keeping health lifestyle as well as pharmacological interventions to delay/prevent the onset of T2DM/pre-diabetes in GDM women.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier (CRD42022314776)
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