Schwartz Naama, Nachum Zohar, Green Manfred S
School of Public Health, University of Haifa, Haifa, Israel; Clinical Research Unit, Emek Medical Center, Afula, Israel.
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Am J Obstet Gynecol. 2015 Sep;213(3):310-7. doi: 10.1016/j.ajog.2015.03.011. Epub 2015 Mar 7.
Reports on the gestational diabetes mellitus (GDM) recurrence rate have been highly variable. Our objectives were to examine the possible causes of GDM recurrence rate variability and to obtain pooled estimates in subgroups. We have carried out a systematic review and metaanalysis based on the Metaanalysis Of Observational Studies in Epidemiology statement. We identified papers published from 1973 to September 2014. We identified papers using Medline (PubMed and Ovid), ClinicalTrials.gov and Google Scholar databases, and published references. We included only English-language, population-based studies that reported specified GDM criteria and GDM recurrence rate. A total of 18 eligible studies with 19,053 participants were identified. We used the Cochrane's Q test of heterogeneity to choose the model for estimating the pooled GDM recurrence rate. Metaregression was also used to explore the possible causes of variability between studies. The pooled GDM recurrence rate was 48% (95% confidence interval, 41-54%). A significant association between ethnicity and GDM recurrence rate was found (P = .02). Non-Hispanic whites had lower recurrence rate compared with other ethnicities (39% and 56%, respectively). Primiparous women had a lower recurrence rate compared with multiparous women (40% and 73%, respectively; P < .0001) No evidence for association between family history of diabetes and GDM recurrence was found. The overall GDM recurrence rate is high. Non-Hispanic whites and primiparous women have substantially lower GDM recurrence rates, which contributes to the variability between studies. Because no association between family history of diabetes and GDM recurrence was found, the large differences between ethnic groups may have also resulted from nongenetic factors. Thus, intervention programs could reduce the GDM recurrence rates.
关于妊娠期糖尿病（GDM）复发率的报告差异很大。我们的目标是研究GDM复发率差异的可能原因，并获得亚组的合并估计值。我们根据流行病学观察性研究的Meta分析声明进行了系统评价和Meta分析。我们确定了1973年至2014年9月发表的论文。我们使用Medline（PubMed和Ovid）、ClinicalTrials.gov和谷歌学术数据库以及已发表的参考文献来确定论文。我们仅纳入了报告特定GDM标准和GDM复发率的英文、基于人群的研究。共确定了18项符合条件的研究，涉及19053名参与者。我们使用Cochrane异质性Q检验来选择估计合并GDM复发率的模型。Meta回归也用于探讨研究间差异的可能原因。合并GDM复发率为48%（95%置信区间，41 - 54%）。发现种族与GDM复发率之间存在显著关联（P = 0.02）。与其他种族相比，非西班牙裔白人的复发率较低（分别为39%和56%）。初产妇的复发率低于经产妇（分别为40%和73%；P < 0.0001）。未发现糖尿病家族史与GDM复发之间存在关联的证据。总体GDM复发率较高。非西班牙裔白人和初产妇的GDM复发率显著较低，这导致了研究间的差异。由于未发现糖尿病家族史与GDM复发之间存在关联，种族群体之间的巨大差异可能也由非遗传因素导致。因此，干预项目可以降低GDM复发率。
