Gestational diabetes mellitus predisposes women to prediabetes, T2DM

Among women with a history of gestational diabetes mellitus (GDM), the conversion to prediabetes or type 2 diabetes mellitus (T2DM) appears to be high, a recent study has found.

Drawing from the online databases of Embase, Medline, Web of Knowledge, and CINAHL, researchers retrieved 13 studies that had reported diabetes outcomes with more than 6 weeks of postpartum follow-up. T2DM was assessed using the WHO criteria, while prediabetes was determined using impaired fasting glucose or glucose tolerance, or a combination of the two.

Pooled analysis of 11 studies showed that prediabetes was detected in 25.9 percent of women with a history of GDM. Meanwhile, 12 studies found a 29.9-percent pooled prevalence of T2DM among these patients. In both cases, the heterogeneity of evidence was high and significant (p<0.001 for both).

In subsequent sensitivity analysis, researchers estimated pooled prevalence of T2DM and diabetes after removing one study at a time. This resulted in a range of rates. For prediabetes, prevalence ranged from 25.0 percent to 27.7 percent, while rates went from 27.2 percent to 33.4 percent for T2DM.

Three studies compared the risk of T2DM in GDM and non-GDM women. Pooled analysis found that a history of GDM aggravated the risk of T2DM by more than 13 times (relative risk, 13.2, 95 percent confidence interval, 9.52–18.29; p<0.001). Not enough studies were available to conduct a similar analysis for prediabetes.

“Despite the lack of adequate data, which requires carefully designed longitudinal studies, these findings highlight the importance of prioritizing women with history of GDM for T2DM prevention strategies,” the researchers said.

“Development of precision medicine would be key for individualized strategies, which is likely to have better adherence rates for both screening and prevention,” they added.