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Diabetologia. 2016 Jul;59(7):1403-1411. doi: 10.1007/s00125-016-3927-2. Epub 2016 Apr 13.

Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women.

Author information

1
Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AB, UK.
2
Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain.
3
CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
4
Multidisciplinary Evidence Synthesis Hub (mEsh), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
5
Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AB, UK. s.thangaratinam@qmul.ac.uk.
6
Multidisciplinary Evidence Synthesis Hub (mEsh), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. s.thangaratinam@qmul.ac.uk.

Abstract

AIMS/HYPOTHESIS:

Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM.

METHODS:

We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model.

RESULTS:

There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk.

CONCLUSIONS/INTERPRETATION:

Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM.

SYSTEMATIC REVIEW REGISTRATION:

www.crd.york.ac.uk/PROSPERO CRD42014013597.

KEYWORDS:

Gestational diabetes; Meta-analysis; Postpartum; Predictors; Pregnancy; Risk factors; Systematic review; Type 2 diabetes

PMID:
27073002
PMCID:
PMC4901120
DOI:
10.1007/s00125-016-3927-2
[Indexed for MEDLINE]
Free PMC Article

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