Abstract
The aim of the study was to assess the postpartum risk for glucose intolerance since the introduction of the ‘International Association of Diabetes and Pregnancy Study Groups’ (IADPSG) criteria for gestational diabetes mellitus (GDM). Studies published since 2010 were included, which evaluated the risk for type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT), and cardiovascular (CV) events in women with previous GDM compared to normal glucose tolerant women. We included forty-three studies, evaluating 4,923,571 pregnant women of which 5.8% (284,312) had a history of GDM. Five studies used IADPSG criteria (n = 6174 women, 1314 with GDM). The overall pooled relative risk (RR) for postpartum T2DM was 7.42 (95% CI: 5.99–9.19) and the RR for postpartum T2DM with IADPSG criteria was 6.45 (95% CI: 4.74–8.77) compared to the RR of 9.08 (95% CI: 6.96–11.85; p = 0.17) for postpartum T2DM based on other diagnostic criteria. The RR for postpartum IGT was 2.45 (95% CI: 1.92–3.13), independent of the criteria used. None of the available studies with IADPSG criteria evaluated the risk for CV events. Women with a history of GDM based on the IADPSG criteria have a similarly increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria. More studies with GDM based on the IADPSG criteria are needed to increase the quality of evidence concerning the long-term metabolic risk.
Highlights
Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy provided that overt diabetes has been excluded in early pregnancy [1]
Women with a history of gestational diabetes mellitus (GDM) based on the IADPSG criteria have a increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria
The present systematic review and meta-analysis of 43 studies, including nearly five million pregnant women of which 6% had prior GDM, showed that women with a history of GDM based on the IADPSG criteria have a increased risk for postpartum glucose intolerance compared to GDM based on other diagnostic criteria and other GDM screening strategies
Summary
Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed in the second or third trimester of pregnancy provided that overt diabetes has been excluded in early pregnancy [1]. Women with a history of GDM are at an increased risk of developing type 2 diabetes mellitus (T2DM) postpartum and have a significantly higher risk of developing a metabolic syndrome and cardiovascular diseases compared to women with normal glucose tolerance (NGT) in pregnancy [2,3]. A systematic review of 2009, published before the introduction of the IADPSG criteria, showed that women with GDM have a seven-fold increased risk of developing T2DM later in life compared to NGT women during pregnancy [2]. A systematic review from 2018 included more recent studies and confirmed the seven-fold increased postpartum risk for T2DM but did not evaluate the postpartum risk based on the IADPSG criteria compared to other criteria [8]. Our objective was to assess the postpartum risk for glucose intolerance and cardiovascular events in women with GDM based on the IADPSG criteria compared to other diagnostic criteria
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