Sonaglioni Andrea, Piergallini Elisabetta, Naselli Angelo, Nicolosi Gian Luigi, Ferrulli Anna, Bianchi Stefano, Lombardo Michele, Ambrosio Giuseppe
Division of Cardiology, IRCCS MultiMedica, Milan, Italy.
Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy.
Acta Diabetol. 2024 Feb;61(2):139-149. doi: 10.1007/s00592-023-02206-9. Epub 2023 Nov 8.
The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA) intima-media thickness (IMT) is still controversial. This systematic review and meta-analysis was performed to assess the correlation between GDM and CCA-IMT in and after pregnancy.
PubMed and EMBASE databases were systematically reviewed on April 2023. Studies measuring CCA-IMT in both pregnant women with GDM and women with previous history of GDM (pGDM) vs. healthy controls were included. The subtotal and overall standardized mean differences (SMDs) of CCA-IMT were calculated using the random-effect model.
Nineteen studies with a total of 302 GDM and 861 pGDM women were analyzed. The average value of CCA-IMT measured in GDM/pGDM (0.59 ± 0.12 mm) was slightly increased in comparison to the accepted reference limits of IMT according to age classes. Substantial heterogeneity was detected for the studies involving both GDM and pGDM women, with an overall statistic I of 86.0% (p < 0.001). Large SMDs were obtained for the studies conducted on both GDM and pGDM women, with an overall SMD of 0.89 (95%CI 0.63-1.15, p < 0.001). Egger's test for a regression intercept gave a p-value of 0.37, indicating no publication bias. On meta-regression analysis, all potential confounders (number of patients, age at pregnancy, body mass index, measuring time, follow-up duration and GDM criteria) were not significantly associated with effect modification.
GDM in and after pregnancy is independently associated with subclinical atherosclerosis. The association between GDM and carotid remodeling is potentially mediated by the longstanding underlying risk.
妊娠期糖尿病（GDM）与颈总动脉（CCA）内膜中层厚度（IMT）之间的关联仍存在争议。本系统评价和荟萃分析旨在评估妊娠期间及产后GDM与CCA-IMT之间的相关性。
于2023年4月对PubMed和EMBASE数据库进行系统检索。纳入测量患有GDM的孕妇和既往有GDM病史（pGDM）的女性与健康对照者的CCA-IMT的研究。使用随机效应模型计算CCA-IMT的汇总和总体标准化均数差（SMD）。
分析了19项研究，共纳入302例GDM女性和861例pGDM女性。与根据年龄分类的IMT公认参考限值相比，GDM/pGDM组测量的CCA-IMT平均值（0.59±0.12mm）略有增加。在涉及GDM和pGDM女性的研究中检测到显著异质性，总体异质性统计I为86.0%（p<0.001）。在针对GDM和pGDM女性进行的研究中获得了较大的SMD，总体SMD为0.89（95%CI 0.63-1.15，p<0.001）。Egger回归截距检验的p值为0.37，表明无发表偏倚。在meta回归分析中，所有潜在混杂因素（患者数量、妊娠年龄、体重指数、测量时间、随访持续时间和GDM标准）与效应修饰均无显著关联。
妊娠期间及产后的GDM与亚临床动脉粥样硬化独立相关。GDM与颈动脉重塑之间的关联可能由长期存在的潜在风险介导。
