Chen Kaiqi, Tang Lichao, Wang Xinwei, Li Yunhua, Zhang Xijian, Cui Shikui, Chen Wei, Jin Zhao, Zhu Danping
School of Basic Medical, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
College of Education, Chengdu College of Arts and Sciences, Chengdu, China.
Front Endocrinol (Lausanne). 2024 Dec 23;15:1486861. doi: 10.3389/fendo.2024.1486861. eCollection 2024.
This study aims to explore the risk factors in the progression of gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM).
Relevant studies were comprehensively searched from PubMed, Web of Science, Cochrane Library, and Embase up to March 12. Data extraction was performed. Differences in risk factors were presented as odds ratios (OR) and corresponding 95% confidence intervals (CI). The quality of the included studies was assessed through the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality scale.
This meta-analysis encompassed 46 studies involving a total of 196,494 patients. The factors most strongly associated with the risk of developing T2DM following GDM were the use of progestin-only contraceptives (odds ratio [OR]: 2.12, 95% confidence interval [CI] = 1.00-4.45, P = 0.049), recurrence of GDM (OR: 2.63, 95% CI = 1.88-3.69, P < 0.001), insulin use during pregnancy (OR: 4.35, 95% CI = 3.17-5.96, P < 0.001), pre-pregnancy body mass index (BMI) (OR: 2.97, 95% CI = 2.16-4.07, P < 0.001), BMI after delivery (OR: 4.17, 95% CI = 2.58-6.74, P < 0.001), macrosomia (OR: 3.30, 95% CI = 1.45-7.49, P = 0.04), hypertension (OR: 5.19, 95% CI = 1.31-20.51, P = 0.019), and HbA1c levels (OR: 3.32, 95% CI = 1.81-6.11, P < 0.001). Additionally, age (OR: 1.71, 95% CI = 1.23-2.38, P = 0.001), family history of diabetes (OR: 1.47, 95% CI = 1.27-1.70, P < 0.001), BMI during pregnancy (OR: 1.06, 95% CI = 1.00-1.12, P = 0.056), fasting blood glucose (FBG) (OR: 1.58, 95% CI = 1.36-1.84, P < 0.001), 1-hour oral glucose tolerance test (OGTT) (OR: 1.38, 95% CI = 1.02-1.87, P = 0.037), and 2-hour OGTT (OR: 1.54, 95% CI = 1.28-1.58, P < 0.001) were identified as moderate-risk factors for the development of T2DM.
The systematic review and meta-analysis identified several moderate- to high-risk factors associated with the progression of T2DM in individuals with a history of GDM. These risk factors include the use of progestin-only contraceptives, pre-pregnancy BMI, BMI after delivery, macrosomia, hypertension, persistently elevated levels of HbA1c, fasting blood glucose (FBG), 1-hour and 2-hour oral glucose tolerance tests (OGTT), age, and family history of diabetes. Our findings serve as evidence for the early prevention and clinical intervention of the progression from GDM to T2DM and offer valuable insights to guide healthcare professionals in formulating customized management and treatment strategies for female patients with diverse forms of GDM.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024545200.
本研究旨在探讨妊娠期糖尿病（GDM）进展为2型糖尿病（T2DM）的危险因素。
截至3月12日，全面检索了来自PubMed、科学网、Cochrane图书馆和Embase的相关研究。进行了数据提取。危险因素的差异以比值比（OR）和相应的95%置信区间（CI）表示。通过纽卡斯尔-渥太华量表和医疗保健研究与质量局量表评估纳入研究的质量。
该荟萃分析纳入了46项研究，共涉及196,494名患者。与GDM后发生T2DM风险最密切相关的因素是仅使用孕激素避孕药（比值比[OR]：2.12，95%置信区间[CI]=1.00 - 4.45，P = 0.049）、GDM复发（OR：2.63，95% CI = 1.88 - 3.69，P < 0.001）、孕期使用胰岛素（OR：4.35，95% CI = 3.17 - 5.96，P < 0.001）、孕前体重指数（BMI）（OR：2.97，95% CI = 2.16 - 4.07，P < 0.001）、产后BMI（OR：4.17，95% CI = 2.58 - 6.74，P < 0.001）、巨大儿（OR：3.30，95% CI = 1.45 - 7.49，P = 0.04）、高血压（OR：5.19，95% CI = 1.31 - 20.51，P = 0.019）和糖化血红蛋白（HbA1c）水平（OR：3.32，95% CI = 1.81 - 6.11，P < 0.001）。此外，年龄（OR：1.71，95% CI = 1.23 - 2.38，P = 0.001）、糖尿病家族史（OR：1.47，95% CI = 1.27 - 1.70，P < 0.001）、孕期BMI（OR：1.06，95% CI = 1.00 - 1.12，P = 0.056）、空腹血糖（FBG）（OR：1.58，95% CI = 1.36 - 1.84，P < 0.001）、1小时口服葡萄糖耐量试验（OGTT）（OR：1.38，95% CI = 1.02 - 1.87，P = 0.037）和2小时OGTT（OR：1.54，95% CI = 1.28 - 1.58，P < 0.001）被确定为发生T2DM的中度危险因素。
系统评价和荟萃分析确定了几个与有GDM病史个体发生T2DM进展相关的中度至高度危险因素。这些危险因素包括仅使用孕激素避孕药、孕前BMI、产后BMI、巨大儿、高血压、HbA1c持续升高、空腹血糖（FBG）、1小时和2小时口服葡萄糖耐量试验（OGTT）、年龄和糖尿病家族史。我们的研究结果为GDM进展为T2DM的早期预防和临床干预提供了证据，并为指导医疗保健专业人员为不同类型GDM的女性患者制定定制化管理和治疗策略提供了有价值的见解。
