The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis

Abstract

The aim of the study was to assess the postpartum risk for glucose intolerance since the introduction of the 'International Association of Diabetes and Pregnancy Study Groups' (IADPSG) criteria for gestational diabetes mellitus (GDM). Studies published since 2010 were included, which evaluated the risk for type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT), and cardiovascular (CV) events in women with previous GDM compared to normal glucose tolerant women. We included forty-three studies, evaluating 4,923,571 pregnant women of which 5.8% (284,312) had a history of GDM. Five studies used IADPSG criteria (n = 6174 women, 1314 with GDM). The overall pooled relative risk (RR) for postpartum T2DM was 7.42 (95% CI: 5.99-9.19) and the RR for postpartum T2DM with IADPSG criteria was 6.45 (95% CI: 4.74-8.77) compared to the RR of 9.08 (95% CI: 6.96-11.85; p = 0.17) for postpartum T2DM based on other diagnostic criteria. The RR for postpartum IGT was 2.45 (95% CI: 1.92-3.13), independent of the criteria used. None of the available studies with IADPSG criteria evaluated the risk for CV events. Women with a history of GDM based on the IADPSG criteria have a similarly increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria. More studies with GDM based on the IADPSG criteria are needed to increase the quality of evidence concerning the long-term metabolic risk.

Keywords: International Association of Diabetes and Pregnancy Study Groups (IADPSG); diagnostic criteria; gestational diabetes mellitus; glucose intolerance; impaired glucose tolerance; myocardial infarction; postpartum; stroke; type 2 diabetes.

Figure 1

The literature search and selection process. N: the number of studies; LILACS: Latin American and Caribbean Health Sciences Literature; T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus; GDM: gestational diabetes mellitus; MI: myocardial infarction. * Retrieved from the systematic review of Song et al. [8].

Figure 2

The overall postpartum risk for glucose intolerance and cardiovascular events in women with a history of GDM compared to NGT women: (A) Type 2 diabetes mellitus (T2DM), (B) prediabetes, (C1) stroke, and (C2) myocardial infarction. T2DM: Type 2 diabetes mellitus; GDM, gestational diabetes mellitus; 95% CI: confidence interval; M–H: Mantel–Haenszel method; df: degrees of freedom; RR: relative risk or risk ratio. X-axis is log scale of RR. Squares represent the RR of an individual study. The size of the square is proportional to the weight of the study, which was calculated using a random-effects model. The horizontal lines indicate 95% CI. The diamond represents the pooled RR with its 95% CI.

Figure 2

The overall postpartum risk for glucose intolerance and cardiovascular events in women with a history of GDM compared to NGT women: (A) Type 2 diabetes mellitus (T2DM), (B) prediabetes, (C1) stroke, and (C2) myocardial infarction. T2DM: Type 2 diabetes mellitus; GDM, gestational diabetes mellitus; 95% CI: confidence interval; M–H: Mantel–Haenszel method; df: degrees of freedom; RR: relative risk or risk ratio. X-axis is log scale of RR. Squares represent the RR of an individual study. The size of the square is proportional to the weight of the study, which was calculated using a random-effects model. The horizontal lines indicate 95% CI. The diamond represents the pooled RR with its 95% CI.