The absolute and relative risk of type 2 diabetes after gestational diabetes: A systematic review and meta-analysis of 129 studies
Rebecca A. Dennison, Eileen S. Chen, Madeline Green, Chloe Legard, Deeya Kotecha, George E. Farmer, Stephen J. Sharp, Rebecca Ward, Juliet A. Usher‐Smith, Simon J. Griffin
Abstract
AimsTo 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.MethodsSystematic 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.ResultsIn 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.ConclusionsPercentage 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.