Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women

Girish Rayanagoudar; Amal A. Hashi; Javier Zamora; Khalid S. Khan; Graham A. Hitman; Shakila Thangaratinam

doi:10.1007/s00125-016-3927-2

Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women

Girish Rayanagoudar, Amal A. Hashi, Javier Zamora, Khalid S. Khan, Graham A. Hitman, Shakila Thangaratinam^*

^*Corresponding author for this work

Metabolism and Systems Research

Research output: Contribution to journal › Review article › peer-review

171 Citations (Scopus)

Abstract

Aims/hypothesis: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM. Methods: We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model. Results: There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA_1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk. Conclusions/interpretation: Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM. Systematic review registration:: www.crd.york.ac.uk/PROSPERO

Original language	English
Pages (from-to)	1403-1411
Number of pages	9
Journal	Diabetologia
Volume	59
Issue number	7
DOIs	https://doi.org/10.1007/s00125-016-3927-2
Publication status	Published - 1 Jul 2016

Bibliographical note

Funding Information:
This independent research was funded by European Union’s Seventh Framework Programme under EC-GA No. 278917 (GIFTS ‘Genomic and lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to prevention strategies in South Asian peoples’). The funding body played no role in designing or conducting the study or preparing the report.

Publisher Copyright:
© 2016, The Author(s).

Keywords

Gestational diabetes
Meta-analysis
Postpartum
Predictors
Pregnancy
Risk factors
Systematic review
Type 2 diabetes

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00125-016-3927-2

Cite this

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title = "Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women",

abstract = "Aims/hypothesis: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM. Methods: We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model. Results: There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk. Conclusions/interpretation: Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM. Systematic review registration:: www.crd.york.ac.uk/PROSPERO",

keywords = "Gestational diabetes, Meta-analysis, Postpartum, Predictors, Pregnancy, Risk factors, Systematic review, Type 2 diabetes",

author = "Girish Rayanagoudar and Hashi, {Amal A.} and Javier Zamora and Khan, {Khalid S.} and Hitman, {Graham A.} and Shakila Thangaratinam",

note = "Funding Information: This independent research was funded by European Union{\textquoteright}s Seventh Framework Programme under EC-GA No. 278917 (GIFTS {\textquoteleft}Genomic and lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to prevention strategies in South Asian peoples{\textquoteright}). The funding body played no role in designing or conducting the study or preparing the report. Publisher Copyright: {\textcopyright} 2016, The Author(s).",

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doi = "10.1007/s00125-016-3927-2",

language = "English",

volume = "59",

pages = "1403--1411",

journal = "Diabetologia",

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T1 - Quantification of the type 2 diabetes risk in women with gestational diabetes

T2 - a systematic review and meta-analysis of 95,750 women

AU - Rayanagoudar, Girish

AU - Hashi, Amal A.

AU - Zamora, Javier

AU - Khan, Khalid S.

AU - Hitman, Graham A.

AU - Thangaratinam, Shakila

N1 - Funding Information: This independent research was funded by European Union’s Seventh Framework Programme under EC-GA No. 278917 (GIFTS ‘Genomic and lifestyle predictors of fetal outcome relevant to diabetes and obesity and their relevance to prevention strategies in South Asian peoples’). The funding body played no role in designing or conducting the study or preparing the report. Publisher Copyright: © 2016, The Author(s).

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Aims/hypothesis: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM. Methods: We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model. Results: There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk. Conclusions/interpretation: Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM. Systematic review registration:: www.crd.york.ac.uk/PROSPERO

AB - Aims/hypothesis: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM. Methods: We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model. Results: There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk. Conclusions/interpretation: Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM. Systematic review registration:: www.crd.york.ac.uk/PROSPERO

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KW - Meta-analysis

KW - Postpartum

KW - Predictors

KW - Pregnancy

KW - Risk factors

KW - Systematic review

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M3 - Review article

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Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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