Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Center for Disease Control and Prevention of Tianjin Economic-Technological Development Area (TEDA), Tianjin, China.
Diabetes Res Clin Pract. 2018 Jun;140:324-338. doi: 10.1016/j.diabres.2018.03.054. Epub 2018 Apr 12.
This study aims to investigate the effect of gestational diabetes mellitus (GDM) on the long-term risk of cardiovascular disease (CVD). PubMed and other databases were searched up to August 31, 2017. Cohort studies evaluating risk of CVD postpartum in women with and without prior GDM were included. Random-effect model was used to estimate the pooled relative risk of CVD. Sensitivity and subgroup analyses were performed to check the consistency of the effect size and to explore sources of heterogeneity. Multivariable logistic regression was used to control for high heterogeneity. Seven cohort studies with 3,417,020 pregnant women including 14,146 incident CVD events were retrieved. In the pooled analysis, women with previous GDM had a higher risk of CVD than those without (RR: 1.74, 95%CI: 1.28-2.35, I = 95.7%). Four studies reported the event of coronary artery disease (CAD) and two studies reported stroke. The overall RR for CAD was 2.09 (95%CI: 1.56-2.80, I = 91.2%) and that for stroke was 1.25 (95%CI: 1.07-1.48). In view of the high level of heterogeneity, adjustments were made for this, with the resulting adjusted OR for CVD and CAD being 1.95 (95%CI: 1.83-2.08) and 1.59 (95%CI: 1.30-1.94). Women with prior GDM have increased risk of CVD.
本研究旨在探讨妊娠期糖尿病（GDM）对心血管疾病（CVD）长期风险的影响。检索了PubMed 和其他数据库，截至 2017 年 8 月 31 日。纳入了评估有和无既往 GDM 的女性产后 CVD 风险的队列研究。采用随机效应模型估计 CVD 的合并相对风险。进行敏感性和亚组分析以检查效应大小的一致性，并探索异质性的来源。多变量逻辑回归用于控制高度异质性。共检索到 7 项队列研究，共纳入 341.702 名孕妇，其中 14146 例发生 CVD 事件。在汇总分析中，既往有 GDM 的女性发生 CVD 的风险高于无 GDM 的女性（RR：1.74，95%CI：1.28-2.35，I²=95.7%）。有 4 项研究报告了冠心病（CAD）事件，有 2 项研究报告了卒中事件。CAD 的总体 RR 为 2.09（95%CI：1.56-2.80，I²=91.2%），卒中的 RR 为 1.25（95%CI：1.07-1.48）。鉴于高度异质性，对此进行了调整，调整后的 CVD 和 CAD 的校正 OR 分别为 1.95（95%CI：1.83-2.08）和 1.59（95%CI：1.30-1.94）。既往有 GDM 的女性发生 CVD 的风险增加。
