GDM is associated with an almost 10-fold greater risk for T2D

  • Vounzoulaki E & al.
  • BMJ
  • 13 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Gestational diabetes mellitus (GDM) is linked to an almost 10-fold increased risk of later developing type 2 diabetes (T2D).
  • The findings suggest the need for postpartum screening and encouragement of lifestyle interventions in patients who have a history of GDM.

Why this matters

  • Previous systematic reviews on this subject were published more than a decade ago.

Study design

  • Systematic review/meta-analysis including 20 studies involving 1,332,373 women, of whom 5.1% (67,956) had GDM.
  • Funding: National Institute for Health Research (UK).

Key results

  • Pooled relative risk (RR) for T2D for women with vs without GDM was 9.51 (P<.001>
  • Pooled RRs (95% CIs) by ethnicity/race: 
    • 16.28 (15.01-17.66) among predominantly white populations,
    • 10.38 (4.61-23.39) in nonwhite populations, and
    • 8.31 (5.44-12.69) in mixed populations.
  • By years of follow-up, estimated pooled RRs (95% CIs):
    • 17.06 (8.95-32.55) for 1-5 years,
    • 10.42 (5.68-19.11) for >5-10 years, and
    • 8.09 (4.34-15.08) for >10 years.
  • Pooled cumulative GDM incidence (95% CIs) by follow-up duration:
    • ~9.22% (7.19%-11.26%) for 1-5 years, and
    • 16.15% (15.83%-16.47%) for >10 years.
  • Cumulative GDM incidence in controls reached 1.90% (95% CI, 1.87%-1.92%) for the longest studies.

Limitations

  • Only English-language studies included.
  • No data on parity or family history of diabetes.
  • Incidence rate ratios could not be calculated.
  • No individual patient-level data.