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

Girish Rayanagoudar, Amal A Hashi, Javier Zamora, Khalid S Khan, Graham A Hitman, Shakila Thangaratinam, Girish Rayanagoudar, Amal A Hashi, Javier Zamora, Khalid S Khan, Graham A Hitman, Shakila Thangaratinam

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.

Figures

Fig. 1
Fig. 1
Flow chart for study selection for the systematic review of the predictors of progression to type 2 diabetes in women with GDM
Fig. 2
Fig. 2
Risk of bias assessment on the Newcastle–Ottawa Scale for studies included in the systematic review of type 2 diabetes prediction in women with GDM. Light grey bars, low risk; mid grey bars, medium risk; dark grey bars, high risk. The numbers of studies are shown
Fig. 3
Fig. 3
Summary estimates for the association of maternal risk factors with progression to type 2 diabetes in women with GDM. ‘Exclusively’ and ‘mostly’ breastfed were combined into a single breastfeeding category. ‘Mixed or inconsistent’ breastfeeding and ‘exclusively or mostly formula fed’ were combined into a single ‘no breastfeeding’ category [17]. Similarly, data reported for age 2 for one study [50] was classified as a BMI of <27 kg/m2 because all other studies used this cut-off value. GA, gestational age

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