Increased risk of cardiovascular disease in women with prior gestational diabetes: A systematic review and meta-analysis

Abstract

This study aims to investigate the effect of gestational diabetes mellitus (GDM) on the long-term risk of cardiovascular disease (CVD). PubMed and other databases were searched up to August 31, 2017. Cohort studies evaluating risk of CVD postpartum in women with and without prior GDM were included. Random-effect model was used to estimate the pooled relative risk of CVD. Sensitivity and subgroup analyses were performed to check the consistency of the effect size and to explore sources of heterogeneity. Multivariable logistic regression was used to control for high heterogeneity. Seven cohort studies with 3,417,020 pregnant women including 14,146 incident CVD events were retrieved. In the pooled analysis, women with previous GDM had a higher risk of CVD than those without (RR: 1.74, 95%CI: 1.28-2.35, I² = 95.7%). Four studies reported the event of coronary artery disease (CAD) and two studies reported stroke. The overall RR for CAD was 2.09 (95%CI: 1.56-2.80, I² = 91.2%) and that for stroke was 1.25 (95%CI: 1.07-1.48). In view of the high level of heterogeneity, adjustments were made for this, with the resulting adjusted OR for CVD and CAD being 1.95 (95%CI: 1.83-2.08) and 1.59 (95%CI: 1.30-1.94). Women with prior GDM have increased risk of CVD.

Keywords: Cardiovascular disease; Gestational diabetes mellitus; Meta-analysis; Pregnancy; Systematic review.