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

• Published in: Diabetes research and clinical practice 2021-01, Vol.171, p.108625-108625, Article 108625
• Main Authors: Dennison, Rebecca A., Chen, Eileen S., Green, Madeline E., Legard, Chloe, Kotecha, Deeya, Farmer, George, Sharp, Stephen J., Ward, Rebecca J., Usher-Smith, Juliet A., Griffin, Simon J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Diabetes Mellitus, Type 2 - etiology; Diabetes, Gestational - diagnosis; Female; Gestational diabetes; Humans; Incidence; Mass Screening; Meta-analysis; Pregnancy; Risk; Risk Factors; Systematic review; Type 2 diabetes; Young Adult
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2020.108625

•A third of women were diagnosed with type 2 diabetes within 15 years after gestational diabetes.•Risk of type 2 diabetes was 8-times higher among women with gestational diabetes.•Risk of diabetes was higher in non-White European and overweight populations.•Women with gestational diabetes represent an easily-identifiable high risk group. 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. 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. 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. 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.