IDF21-0526 Risk Factors for Gestational Diabetes Mellitus Recurrence: A Systematic Review

Abstract

Background: Gestational diabetes mellitus (GDM) is a common obstetric complication and is related to numerous short-term and long-term adverse outcomes such as the increased risk of recurrence in a subsequent pregnancy. The frequency of GDM recurrence ranges from around 30–84% depending on population studies and diagnostic criteria. Although risk factors related to GDM recurrence have been studied widely, the results are sometimes contradictory. Aim: A systematic review was performed to identify risk factors for GDM recurrence in selected previous studies. Method: The eligible publication was screened using inclusion criteria such as 1) the study included minimal 1 month follow up; 2) be compared to a control group; 3) carried by the English language; 4) published at least from 2010, and; 5) observational dan clinical trial. Any situation which altered endocrinologic status, abstracts only, case reports, letters, comments, or reviews; animal studies; duplicate studies; and no population of interest. was set as exclusion criteria. Studies were searched using keywords: (Recurrence) AND (Gestational Diabetes Mellitus) AND (Risk factor) in several databases of Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Google Scholar. All papers were reviewed using critical appraisal for clinical trials by the Centre for Evidence-Based Medicine Oxford University while the risk of bias was determined by Cochrane Handbook for Systematic Reviews of Interventions (PRISMA). Twenty-five papers were initially collected using MESH in advanced search, five are duplicates and ten articles were not met inclusion criteria. Sixteen studies pooled and entered review synthesis. Results: Twenty-five articles were identified; 10 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied around 40%. Higher rates were associated with non-Hispanic white populations, Asian population; maternal age, family history of diabetes, GDM history in previous pregnancy, insulin use, inter-pregnancy interval, weight gained, and trimester triglyceride concentrations. Discussion: Race is correlated with genetic factors such as TCF7L2 and CDKAL1 and has play role in GDM. Women aged above 35 years in recent decades have had higher risks of GDM. Several studies have demonstrated that the TyG index was a predictor of HOMA-IR in predicting insulin resistance and reported associated with GDM. The risk of developing GDM increased with the number of GDM history in previous pregnancy. Women who gained BMI units between pregnancies are related with higher risk of developing GDM in subsequent pregnancy. A study demonstrated insulin use correlated with GDM recurrence (adj. PR = 1.39 [95% CI: 1.18, 1.62], p < 0.0001). Higher triglyceride concentration in first trimester of subsequent pregnancy has potential to be a predictive value of GDM recurrence. Understanding the risk factors of GDM recurrence could help to anticipate obstetric complications and treat patients better. Limitations of these studies are the heterogeneity of the population and various diagnostic criteria among studies.