Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women

Abstract

Objective. The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size ≥300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results. Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6‰. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions. The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980.

14. Management of Diabetes in Pregnancy:Standards of Medical Care in Diabetes—2021

“…Women of reproductive age with prediabetes may develop type 2 diabetes by the time of their next pregnancy and will need preconception evaluation. Because GDM is associated with an increased lifetime maternal risk for diabetes estimated at 50-60% (107,108), women should also be tested every 1-3 years thereafter if the 4-12 weeks postpartum 75-g OGTT is normal. Ongoing evaluation may be performed with any recommended glycemic test (e.g., annual A1C, annual fasting plasma glucose, or triennial 75-g OGTT using nonpregnant thresholds).…”

“…Women with a history of GDM have a greatly increased risk of conversion to type 2 diabetes over time (108). Women with GDM have a 10-fold increased risk of developing type 2 diabetes compared with women without GDM (107).…”

“…Women with GDM have a 10-fold increased risk of developing type 2 diabetes compared with women without GDM (107). Absolute risk increases linearly through a woman's lifetime, being approximately 20% at 10 years, 30% at 20 years, 40% at 30 years, 50% at 40 years, and 60% at 50 years (108). In the prospective Nurses' Health Study II (NHS II), subsequent diabetes risk after a history of GDM was significantly lower in women who followed healthy eating patterns (109).…”

Effect of mobile health based peripartum management of gestational diabetes mellitus on postpartum diabetes: A randomized controlled trial

“…Women with GDM have a higher risk of cesarean section, pregnancy induced hypertension [5][6][7], as well as developing type 2 diabetes mellitus (T2DM) after delivery [8][9][10][11]. Offsprings with in utero exposure to GDM have increased rates of large for gestational age [12,13], macrosomia [14], and early onset cardiovascular disease from childhood to early adulthood [15,16].…”

Association between neonatal birthweight and risk of maternal glucose intolerance after gestational diabetes mellitus

“…Gestational diabetes mellitus (GDM) identifies women who have a defect in β‐cell function, such that they are unable to secrete sufficient insulin to fully compensate for the insulin resistance of pregnancy 1 . Our previous study showed that the risk of developing type 2 diabetes in women with previous GDM increased linearly by 9.6‰ for every additional 1 year of follow up, and almost one‐fifth of women with GDM would develop type 2 diabetes when the follow‐up duration extended to 10 years 2 . Even in the early postpartum period, women with a diagnosis of GDM are up to 50% likely to develop glucose intolerance 3 .…”