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Cited by 214Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

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, Farmer, George, Sharp, Stephen J., Ward, Rebecca J. +2 more·2021·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2020.108625PMC PMC7610694
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Abstract

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 (I 2 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.

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  • The risk of later T2DM after GDM is especially high for individuals with high severity or postpartum continuation of glucose intolerance and high BMI.

    “This risk is especially high for individuals with a high severity or postpartum continuation of glucose intolerance and high BMI199–201.”

    From A global view of hypertensive disorders and diabetes mellitus during pregnancy (2022) · cites this paper as [200]

    The Introduction says poorer glucose tolerance during pregnancy has been suggested to increase later T2DM risk, and the Discussion reports higher progression among women with high BMI at follow-up. The cited passages do not establish that glucose intolerance continuing after delivery is a particular risk factor. (LLM, conf=0.85)

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  • Women with GDM have a much higher risk of developing impaired glucose tolerance and T2DM in later life than women with uncomplicated pregnancies.

    “Women with GDM have a much higher risk of developing impaired glucose tolerance and T2DM in later life than women with uncomplicated pregnancies7,195–201”

    From A global view of hypertensive disorders and diabetes mellitus during pregnancy (2022) · cites this paper as [200]

    The Results (Relative risk of T2DM; page not provided) report that women with GDM were 8.3 times more likely to develop T2DM than women with normoglycaemic pregnancies. The Introduction associates GDM with higher long-term risk of glucose intolerance, but does not establish that the risk of specifically impaired glucose tolerance is much higher than in women with uncomplicated pregnancies. (LLM, conf=0.85)

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  • Development of type 2 diabetes is 18% higher per unit of BMI increase from prepregnancy BMI at follow-up.

    “Development of type 2 diabetes is 18% higher per unit of BMI increase from prepregnancy BMI at follow-up, highlighting the importance of effective weight management after GDM (138).”

    From 15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [138]

    The Results (Absolute risk of T2DM) report 18% more T2DM development for each study-level unit higher BMI at follow-up. They do not report an 18% increase per unit of BMI gained since prepregnancy; the same section says prepregnancy BMI did not influence the estimates. The finding is an association between studies, not a measured effect of individual weight change. (LLM, conf=0.91)

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Research works printed but not linked: 1

  1. [11]National Institute for Health Care and Excellence Diabetes in pregnancy: management from preconception to the postnatal period NICE Clin Guidel 2015 13 2 65 32212588

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Authors
Dennison, R. A., Chen, E. S., Green, M. E., Legard, C., Kotecha, D., Farmer, G., Sharp, S. J., Ward, R. J., Usher-Smith, J. A., & Griffin, S. J.
Affiliations
University of Cambridge (GB)
Corresponding author
  • Dennison, Rebecca A.
  • Kotecha, Deeya
  • Farmer, George
  • Sharp, Stephen J.
  • Ward, Rebecca J.
  • Griffin, Simon J.
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2021-01
Volume
171
Pages
108625
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2020.108625
PMC
PMC7610694
OpenAlex
W3111270620
Cited by
214
References
46
Citations by year
2026: 56 · 2025: 47 · 2024: 39 · 2023: 27 · 2022: 31 · 2021: 14
FWCI
2.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by-nc-nd)
  • Apollo
Funders
  • Cancer Research UK (A21464, 21464)
  • Medical Research Council (MC_UU_12015/4)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
gestational diabetes mellitus, type 2 diabetes, postpartum diabetes risk, diabetes progression, body mass index, ethnicity, racial disparities, diabetes screening, risk factors
MeSH terms
Adolescent, Adult, Diabetes Mellitus, Type 2, Female, Humans, Mass Screening, Pregnancy, Risk, Risk Factors, Diabetes, Gestational, Young Adult

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