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The absolute and relative risk of type 2 diabetes after gestational diabetes: A systematic review and meta-analysis of 129 studies.

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Dennison, Rebecca A 
Chen, Eileen S 
Green, Madeline E 
Legard, Chloe 
Kotecha, Deeya 


AIMS: To estimate development of type 2 diabetes (T2DM) in women with previous gestational diabetes (GDM) and investigate characteristics associated with higher diagnoses, building on previous meta-analyses and exploring heterogeneity. METHODS: Systematic literature review of studies published up to October 2019. We included studies reporting progression to T2DM ≥6 months after pregnancy, if diagnostic methods were reported and ≥50 women with GDM participated. We conducted random-effects meta-analyses and meta-regression of absolute and relative T2DM risk. PROSPERO ID: CRD42017080299. RESULTS: In 129 included studies, the percentage diagnosed with T2DM was 12% (95% confidence interval 8-16%) higher for each additional year after pregnancy, with a third developing diabetes within 15 years. Development was 18% (5-34%) higher per unit BMI at follow-up, and 57% (39-70%) lower in White European populations compared to others (adjusted for ethnicity and follow-up). Women with GDM had a relative risk of T2DM of 8.3 (6.5-10.6). 17.0% (15.1-19.0%) developed T2DM overall, although heterogeneity between studies was substantial (I2 99.3%), and remained high after accounting for various study-level characteristics. CONCLUSIONS: Percentage developing T2DM after GDM is highly variable. These findings highlight the need for sustained follow-up after GDM through screening, and interventions to reduce modifiable risk factors.



Gestational diabetes, Incidence, Meta-analysis, Systematic review, Type 2 diabetes, Adolescent, Adult, Diabetes Mellitus, Type 2, Diabetes, Gestational, Female, Humans, Mass Screening, Pregnancy, Risk, Risk Factors, Young Adult

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Diabetes Res Clin Pract

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Elsevier BV
Medical Research Council (MC_UU_12015/4)
MRC (MC_UU_00006/6)
Cancer Research UK (21464)
RD was funded by a PhD studentship from the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR; SPCR-S-S102). This paper presents independent research funded by the NIHR SPCR. The views expressed are those of the author(s) and not necessarily those of the NIHR, the NHS or the Department of Health. RW was funded by an NIHR Academic Clinical Fellowship. JUS was funded by a Cancer Research UK Cancer Prevention Fellowship (C55650/A21464). SG was supported by the Medical Research Council (MC_UU_12015/4). The University of Cambridge has received salary support in respect of SG from the NHS in the East of England through the Clinical Academic Reserve.