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Risk of developing metabolic syndrome after gestational diabetes mellitus - a systematic review and meta-analysis

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Abstract

Purpose

A systematic review and meta-analysis were conducted to quantitatively synthesize the current evidence regarding the risk of developing metabolic syndrome (MetS) in women with a personal history of gestational diabetes mellitus (GDM), without pre-existing diabetes, compared with those without a history of GDM.

Methods

Four electronic databases [MEDLINE (via PubMed), Scopus, Cochrane Library, PROSPERO] were searched for relevant literature until July 29th 2020. Cochran’s Q test was applied for the assessment of heterogeneity. The random-effects model was applied by calculating the odds ratio (OR) and 95% confidence interval (CI) for each study. Publication bias was estimated with Egger’s linear regression test.

Results

The results from 23 studies (10,230 pregnant women; 5169 cases, 5061 controls), indicated that women with a history of GDM had a higher risk of developing MetS compared with those without such a history (OR 3.45; 95% CI 2.80–4.25, p < 0.0001). This risk remained higher, independently of maternal age and ethnicity (although the risk was not as high in Asians; OR 2.11; 95% CI 1.27–3.52). The risk of developing MetS was even higher in studies where women with GDM had increased body mass index (BMI) compared with the controls (OR 4.14; 95% CI 3.18–5.38).

Conclusions

The risk for developing MetS following delivery is higher in women with a history of GDM compared with women without such a history. Timely recognition and appropriate intervention are critical to halt progression to MetS and its associated morbidity.

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Data availability

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Code availability

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Abbreviations

ADA:

American Diabetes Association

AHA/NHLBI:

American Heart Association/National Heart, Lung, and Blood Institute

ALAD:

Latin American Diabetes Association

apoB:

Apolipoprotein B

BMI:

Body mass index

BP:

Blood pressure

CI:

Confidence interval

CRP:

C-reactive protein

CVD:

Cardiovascular disease

Fig.:

Figure

GDM:

Gestational diabetes mellitus

HDL-c:

High-density lipoprotein cholesterol

IADPSG:

International Association of Diabetes and Pregnancy Study Groups

IDF:

International Diabetes Federation

IFG:

Impaired fasting glucose

MetS:

Metabolic syndrome

NCEP-ATPIII:

National Cholesterol Education Program Adult Treatment Panel III criteria

NDDG:

National Diabetes Data Group

NICE:

National Institute for Health and Care Excellence

NOS:

Newcastle–Ottawa scale

OR:

Odds ratio

PPAR:

Peroxisome proliferator-activated receptor

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

TG:

Triglycerides

WC:

Waist circumference

WHO:

World Health Organization

WHR:

Waist-to-hip ratio

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Authors and Affiliations

  1. 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    A. Tranidou, T. Dagklis, I. Tsakiridis, A. Siargkas & A. Mamopoulos

  2. Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    A. Tranidou, A. Siargkas, A. Apostolopoulou & M. Chourdakis

  3. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    D. G. Goulis

  4. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    M. Chourdakis

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Contributions

AT, TD and MC conceived the study. AT and AS performed data extraction and quality assessment of the included studies. AT carried out the statistical analysis of the data. AA and IT resolved any disagreements between AT and AS. TD, MC, IT, AM and DG assessed the quality of the manuscript. AT drafted the manuscript. MC, TD and DG critically revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to M. Chourdakis.

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Tranidou, A., Dagklis, T., Tsakiridis, I. et al. Risk of developing metabolic syndrome after gestational diabetes mellitus - a systematic review and meta-analysis. J Endocrinol Invest 44, 1139–1149 (2021). https://doi.org/10.1007/s40618-020-01464-6

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