Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Diabetes Res. 2020 Apr 27;2020:3076463. doi: 10.1155/2020/3076463. eCollection 2020.
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. . 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.
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.
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.
妊娠期糖尿病（GDM）后 2 型糖尿病（T2DM）的报告发病率差异很大。本荟萃分析的目的是确定有 GDM 病史的女性中 T2DM 的发病率，并探讨可能影响该发病率的因素。我们在 PubMed 和 Embase 中搜索了截至 2019 年 1 月与 GDM 后 T2DM 相关的术语。纳入了样本量≥300 且随访时间至少 1 年的大型队列研究。提取选定研究的数据，并使用随机效应模型进行荟萃分析。亚组分析基于妊娠期糖尿病的样本量、地理位置、母亲年龄、体重指数、诊断标准和随访时间。
共纳入 28 项研究，涉及 170139 名 GDM 女性和 34627 例 T2DM 病例。GDM 后 T2DM 的总发病率为 26.20（95%CI，23.31-29.10）/1000 人年。来自亚洲的女性和年龄较大以及体重指数较高的女性似乎患 T2DM 的风险更高。当应用 IADPSG（7.16/1000 人年）诊断 GDM 时，T2DM 的发病率最低。随着随访时间的延长，GDM 后发生 T2DM 的风险呈线性增加。每年随访的增量估计为 9.6‰。估计 T2DM 的风险分别为 10 年时为 19.72%，20 年时为 29.36%，30 年时为 39.00%，40 年时为 48.64%，50 年时为 58.27%。
GDM 后 T2DM 发病率非常高的发现为长期产后 T2DM 发展轨迹提供了重要见解，可为顾问提供证据，并可能促使更多 GDM 女性筛查 T2DM。本试验已在 PROSPERO 登记，注册号为 CRD42019128980。
