Rayanagoudar Girish, Hashi Amal A, Zamora Javier, Khan Khalid S, Hitman Graham A, Thangaratinam Shakila
Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AB, UK.
Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain.
Diabetologia. 2016 Jul;59(7):1403-1411. doi: 10.1007/s00125-016-3927-2. Epub 2016 Apr 13.
AIMS/HYPOTHESIS: Women with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM.
We systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model.
There were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk.
CONCLUSIONS/INTERPRETATION: Personalised risk of progression to type 2 diabetes should be communicated to mothers with GDM.
www.crd.york.ac.uk/PROSPERO CRD42014013597.
目的/假设：妊娠期糖尿病（GDM）女性有患2型糖尿病的风险，但个体风险评估尚不清楚。我们进行了一项荟萃分析，以量化GDM女性进展为2型糖尿病的风险。
我们系统检索了主要电子数据库，无语言限制。两名审阅者独立提取二分类数据的2×2表格以及连续数据的均值和标准误。使用随机效应模型计算并汇总风险比。
有39项相关研究（包括95750名女性），体重指数（风险比1.95 [95%置信区间1.60, 2.31]）、糖尿病家族史（风险比1.70 [95%置信区间1.47, 1.97]）、非白人种族（风险比1.49 [95%置信区间1.14, 1.94]）和高龄产妇（风险比1.20 [95%置信区间1.09, 1.34]）与未来患2型糖尿病的风险相关。GDM早期诊断（风险比2.13 [95%置信区间1.52, 3.56]）、空腹血糖升高（风险比3.57 [95%置信区间2.98, 4.04]）、糖化血红蛋白升高（风险比2.56 [95%置信区间2.00, 3.17]）和使用胰岛素（风险比3.66 [95%置信区间2.78, 4.82]）会增加风险。多胎妊娠（风险比1.23 [95%置信区间1.01, 1.50]）、妊娠期高血压疾病（风险比1.38 [95%置信区间1.32, 1.45]）和早产（风险比1.81 [95%置信区间1.35, 2.43]）与未来患糖尿病相关。孕期体重增加、子代巨大儿或母乳喂养不会增加风险。
结论/解读：应将进展为2型糖尿病的个性化风险告知患有GDM的母亲。
www.crd.york.ac.uk/PROSPERO CRD42014013597。
