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有既往妊娠糖尿病史的女性的心血管危险因素:系统评价和荟萃分析。

Cardiovascular risk factors in women with previous gestational diabetes mellitus: A systematic review and meta-analysis.

机构信息

Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.

Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.

出版信息

Rev Endocr Metab Disord. 2021 Dec;22(4):729-761. doi: 10.1007/s11154-020-09587-0. Epub 2020 Oct 27.

Abstract

This systematic review and meta-analysis aimed to synthesize evidence on conventional cardiovascular disease (CVD) risk factors among women with previous Gestational Diabetes Mellitus (GDM). The review protocol is registered with PROSPERO (CRD42019118149). PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Studies reporting on CVD risk factors in women with previous GDM compared to women without previous GDM were selected. A total of 139 studies were eligible, of which 93 were included in the meta-analysis. Women with previous GDM have significantly higher systolic blood pressure (2.47 mmHg 95% CI 1.74 to 3.40, n = 48, 50,118 participants) diastolic blood pressure (1.89 mmHg 95% CI 1.32 to 2.46, n = 48, 49,495 participants), BMI (1.54 kg/m 95% CI 1.32 to 2.46, n = 78, 255,308 participants), total cholesterol (0.26 SMD 95% CI 0.15 to 0.37, n = 48, 38,561 participants), LDL cholesterol (0.19 SMD 95% CI 0.08 to 0.30, n = 44, 16,980 participants), triglycerides (0.56 SMD 95% CI 0.42 to 0.70, n = 46, 13,175 participants), glucose (0.69 SMD 95% CI 0.56 to 0.81, n = 55, 127,900 participants), insulin (0.41 SMD 95% CI 0.23 to 0.59, n = 32, 8881 participants) and significantly lower HDL cholesterol (-0.28 SMD 95% CI -0.39 to -0.16, n = 56, 35,882 participants), compared to women without previous GDM. The increased blood pressure, total cholesterol, triglycerides and glucose are seen as early as <1 year post-partum.Women with previous GDM have a higher risk of CVD based on significant increases in conventional risk factors. Some risk factors are seen as early as <1 year post-partum. Women with GDM may benefit from early screening to identify modifiable CVD risk factors.

摘要

本系统评价和荟萃分析旨在综合既往妊娠糖尿病(GDM)女性的常规心血管疾病(CVD)风险因素的证据。该综述方案已在 PROSPERO(CRD42019118149)中注册。检索了 PubMed、CINAHL、SCOPUS 和 EMBASE 数据库。选择了报告既往 GDM 女性与无既往 GDM 女性 CVD 风险因素的研究。共有 139 项研究符合条件,其中 93 项纳入荟萃分析。既往 GDM 女性的收缩压(2.47mmHg 95%CI 1.74 至 3.40,n=48,50118 名参与者)、舒张压(1.89mmHg 95%CI 1.32 至 2.46,n=48,49495 名参与者)、BMI(1.54kg/m 95%CI 1.32 至 2.46,n=78,255308 名参与者)、总胆固醇(0.26SMD 95%CI 0.15 至 0.37,n=48,3838561 名参与者)、低密度脂蛋白胆固醇(0.19SMD 95%CI 0.08 至 0.30,n=44,16980 名参与者)、甘油三酯(0.56SMD 95%CI 0.42 至 0.70,n=46,13175 名参与者)、葡萄糖(0.69SMD 95%CI 0.56 至 0.81,n=55,127900 名参与者)和胰岛素(0.41SMD 95%CI 0.23 至 0.59,n=32,8881 名参与者)均显著高于无既往 GDM 女性,而高密度脂蛋白胆固醇(-0.28SMD 95%CI -0.39 至 -0.16,n=56,35882 名参与者)则显著低于无既往 GDM 女性。产后<1 年即可观察到血压、总胆固醇、甘油三酯和葡萄糖的升高。既往 GDM 女性的 CVD 风险增加,这是基于常规风险因素的显著增加。一些风险因素在产后<1 年内就已经出现。GDM 女性可能受益于早期筛查,以识别可改变的 CVD 风险因素。

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