The Risk for Glucose Intolerance after Gestational Diabetes Mellitus since the Introduction of the IADPSG Criteria: A Systematic Review and Meta-Analysis

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.

Historia metabólica de pacientes con antecedentes de diabetes gestacional. Seguimiento durante seis años (2013-2019)

“…Se investigó la evolución metabólica de 44 mujeres con diagnóstico de DG en un Hospital Público donde se realizaron 1.238 partos con niños nacidos vivos, lo que representó una prevalencia de 3,7% que se correspondió con similares resultados encontrados en Argentina 6 y menor al 5 al 18% en otros países 4,13 .…”

“…Para el clínico, el seguimiento de mujeres con DG tiene un sentido preventivo del posible desarrollo del síndrome metabólico y sus consecuencias a largo plazo si no se actúa prontamente en este proceso evolutivo, pudiendo presentar las pacientes entre una de sus consecuencias 1,5 veces más riesgo cardiovascular que las mujeres con tolerancia a la glucosa normal 22,23 . En un estudio de 32 años de seguimiento a pacientes con DG, los autores sitúan al médico clínico como conocedor de los antecedentes e interventor en la prevención de la aparición de las complicaciones cardiovasculares 13 . Es posible que determinar factores de riesgo como los AFD e intervenir sobre los mismos pueda disminuir la prevalencia de DM2 ya que serían un indicador del aumento de esa enfermedad en la población 24 .…”

Sex and Gender Determinants of Increased Blood Pressure Among Women With Previous Gestational Diabetes Mellitus in Rural China

“…Ethnicity was categorized as Han and minority. According to the major periods for discerning glucose metabolic abnormality reported by previous studies, the time since delivery was classi ed into four categories: ≤3 months, > 3 to ≤ 12 months, > 12 to ≤ 36 months, and > 36 months (40,41). Education was categorized as junior high school and below (< 12 years of schooling) and senior high school and above (≥ 12 years of schooling).…”

Pregnancy-related interventions in mothers at risk for gestational diabetes in Asian India and low and middle-income countries (PRIMORDIAL study): protocol for a randomised controlled trial

“… 13 The hyperglycaemia of GDM rapidly abates following delivery and normoglycaemia usually returns within 12 weeks. However, 50%–70% of GDM mothers progress to T2D within 5–10 years postpartum 14 suggesting that GDM may be a prodrome of ‘common T2D’ and may reflect the underlying T2D frequency in the community. 15 …”