Diabetes incidence and influencing factors in women with and without gestational diabetes mellitus: A 15 year population-based follow-up cohort study

Minooee, Sonia; Tehrani, Fahimeh Ramezani; Rahmati, Maryam; Mansournia, Mohammad Alì; Azizi, Fereidoun

doi:10.1016/j.diabres.2017.04.003

Cited by 26 publications

(31 citation statements)

References 32 publications

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“…Of these, 119 were conference proceedings, 72 did not explore outcomes in a group with GDM and a healthy control group, 24 reported postpartum follow-up for a period shorter than 12 months, 15 were not relevant to the research question, 6 did not report the incidence of T2DM, 10 were cross sectional studies, 8 included patients with a self-reported diagnosis of diabetes (either GDM or T2DM or both), 5 were letters and commentaries, 2 were systematic reviews, 2 reported screening in patients already diagnosed with impaired glucose tolerance after GDM, 1 did not compare patients with GDM with a healthy population, and 1 reported information about screening but not progression. Tehrani et al25 and Hakkarainen et al26 assessed the same cohorts as Minooee et al27 and Huopio et al,28 respectively. We included the last two studies because these reported the most relevant data for the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The 20 studies included in this systematic review and meta-analysis had differing lengths of follow-up, time of screening, ethnic origin of study participants, and diagnostic criteria for both GDM and T2DM 2728313334353637383940414243444546474849. All studies were observational, seven were described as prospective cohorts, six as retrospective cohorts, four as population based studies, two as follow-up studies, and one as a hospital based study.…”

Section: Resultsmentioning

confidence: 99%

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Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

630

476

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ObjectiveTo estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.DesignSystematic review and meta-analysis.Data sourcesMedline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.Eligibility criteria for selecting studiesObservational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.ResultsThis meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.ConclusionsWomen with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.Systematic review registrationPROSPERO CRD42019123079.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

630

476

View full text Add to dashboard Cite

show abstract

“…Studies on women with preexisting diabetes have revealed higher rates of complications compared to the general population, including perinatal mortality, congenital malformations, hypertension, preterm delivery, large-for-gestational age (LGA) infants, Cesarean delivery and other neonatal morbidities (6,8).…”

Section: Discussionmentioning

confidence: 99%

“…Blood glucose at 2 hours greater than or equal to 155 mg/ dl 4. Glucose at 3 hours greater than or equal to 140 mg/ dl Other tests (glycated hemoglobin, random postprandial or fasting blood sugar levels) are not recommended because of their low sensitivity (1,8).…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes – Diagnostic and therapeutic novelties

Chioveanu¹,

Bălălău²,

Sima³

et al. 2019

J Clin Invest Surg.

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The prevalence of diabetes during pregnancy has been steadily increasing in the US, mainly gestational diabetes (approximately 90% of the cases). The other types of diabetes during pregnancy are type 1 and type 2 diabetes mellitus. Pre-existing type 2 diabetes mellitus represents approximately 8% of all types of diabetes during pregnancy. The increase in the prevalence of gestational diabetes occurred in parallel with the increase in the prevalence of obesity. The diagnosis of gestational diabetes is made either through one-step or two-step strategy in pregnant women between 24 and 28 weeks of gestation. Diabetes screening is also recommended at the first prenatal visit to women with increased risk factors for diabetes. The management of diabetes during pregnancy involves nutritional medical therapy and/ or pharmacological treatment, in order to achieve the glycemic targets that have been associated with the lowest risk of maternal and fetal complications. Considering the possibility of diabetic complications (retinopathy) during pregnancy, the screening of women with pre-existing diabetes is also necessary. Moreover, gestational diabetes has been associated with an increase in the risk of developing maternal type 2 diabetes, in approximately 50-70% of the cases, after the age of 15-25 years. Therefore, it is recommended to test women with gestational diabetes, between 4-12 weeks' post-partum, using the oral glucose tolerance test (OGTT). If the results are normal, the test should be performed every 1 to 3 years.

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“…About 10% of pregnancies are affected by gestational diabetes mellitus (GDM) [1] which causes multiple adverse fetal and maternal health outcomes [2]. The risk of developing T2DM among women with a history of GDM is 2-10 fold greater compared to those with a healthy pregnancy [3,4]. Similarly, thyroid disorders, the most common endocrine disorders in women of childbearing age [2], are more prevalent in pregnant women with GDM, compared to their healthy counterparts [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the simultaneous effect of hypothyroidism and thyroid autoimmunity with gestational diabetes on the incidence of type 2 diabetes

Zahedi

Davoodi

Tehrani

et al. 2020

Preprint

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Introduction: Despite the evidence available on the adverse impact of gestational diabetes (GDM) and thyroid disorders on developing type 2 diabetes (T2DM), the concurrent influence of these disorders on the incidence of T2DM has not been reported yet. Methods: In this prospective study, 1894 non-diabetic women aged 20 to 60 years, with a history of at least one term delivery, without diagnosed hyperthyroidism were selected at the initiation of the Tehran Thyroid Study (TTS). Pooled logistic regression analyses were used to investigate the association of GDM, thyroid disorders i.e., hypothyroidism and/or thyroid peroxidase antibody (TPOAb) positivity and interaction between GDM and thyroid disorders with the risk of incident T2DM. Results: Of the 1894 participants of the present study, 346 (18.3%) had a history of GDM, and 832 (43.9%) had thyroid disorders. The total cumulative incidence rate of T2DM at the median follow-up time of ~ 12 years was overall 12/1000 person-years (95% confidence interval (CI): 10/1000–13/1000), with an incidence rate of 16/1000 (95%CI: 13/1000–20/1000) in women with GDM; and 11/100,000 (95%CI: 9/100,000–12/1000) among those without GDM. After adjustment for age, the risk of incident T2DM increased among individuals with previous GDM compared to women without a history of GDM (odds ratio (OR): 1.54, 95%CI: 1.06, 2.25). No significant associations were found between either thyroid disorders or the interaction between GDM and thyroid disorders with the development of T2DM; (OR: 1.14, 95%CI: 0.82, 1.58) and (OR: 1.27, 95%CI: 0.66, 2.43), respectively. Conclusion: GDM and thyroid disorders have no concurrent impacts on the incidence of T2DM.

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Diabetes incidence and influencing factors in women with and without gestational diabetes mellitus: A 15 year population-based follow-up cohort study

Cited by 26 publications

References 32 publications

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Gestational diabetes – Diagnostic and therapeutic novelties

Assessment of the simultaneous effect of hypothyroidism and thyroid autoimmunity with gestational diabetes on the incidence of type 2 diabetes

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