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Meta-Analysis
. 2021 Jan:171:108625.
doi: 10.1016/j.diabres.2020.108625. Epub 2020 Dec 15.

The absolute and relative risk of type 2 diabetes after gestational diabetes: A systematic review and meta-analysis of 129 studies

Rebecca A Dennison  1 , Eileen S Chen  2 , Madeline E Green  2 , Chloe Legard  2 , Deeya Kotecha  3 , George Farmer  4 , Stephen J Sharp  5 , Rebecca J Ward  6 , Juliet A Usher-Smith  7 , Simon J Griffin  8
Affiliations
Meta-Analysis

The absolute and relative risk of type 2 diabetes after gestational diabetes: A systematic review and meta-analysis of 129 studies

Rebecca A Dennison et al. Diabetes Res Clin Pract. 2021 Jan.

Abstract

Aims: To estimate development of type 2 diabetes (T2DM) in women with previous gestational diabetes (GDM) and investigate characteristics associated with higher diagnoses, building on previous meta-analyses and exploring heterogeneity.

Methods: Systematic literature review of studies published up to October 2019. We included studies reporting progression to T2DM ≥6 months after pregnancy, if diagnostic methods were reported and ≥50 women with GDM participated. We conducted random-effects meta-analyses and meta-regression of absolute and relative T2DM risk.

Prospero id: CRD42017080299.

Results: In 129 included studies, the percentage diagnosed with T2DM was 12% (95% confidence interval 8-16%) higher for each additional year after pregnancy, with a third developing diabetes within 15 years. Development was 18% (5-34%) higher per unit BMI at follow-up, and 57% (39-70%) lower in White European populations compared to others (adjusted for ethnicity and follow-up). Women with GDM had a relative risk of T2DM of 8.3 (6.5-10.6). 17.0% (15.1-19.0%) developed T2DM overall, although heterogeneity between studies was substantial (I2 99.3%), and remained high after accounting for various study-level characteristics.

Conclusions: Percentage developing T2DM after GDM is highly variable. These findings highlight the need for sustained follow-up after GDM through screening, and interventions to reduce modifiable risk factors.

Keywords: Gestational diabetes; Incidence; Meta-analysis; Systematic review; Type 2 diabetes.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1. PRISMA diagram for the systematic review.
Figure 2
Figure 2. Scatter plot showing the percentage of women developing T2DM after GDM by average study follow-up duration.
Circle size indicates weight given to each study; line of best fit and 95% confidence region (grey shaded area) estimated from meta-regression. N=108 studies and 226,497 women.
Figure 3
Figure 3. Map showing the crude percentage and 95% confidence intervals of women with T2DM after GDM by region, estimated using random-effects meta-analysis.
Figure 4
Figure 4. The crude relative risk of T2DM after GDM compared to normoglycaemic pregnancies.
Annualised incidence rates are only presented for studies reporting average follow-up. Studies are ordered by date of pregnancy.
See this image and copyright information in PMC

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