Perinatal & Pediatric
The association of various degree of hyperglycemia in pregnancy with future risk of diabetes among women with and without a diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis Na Zeng* Na Zeng Wendy Wen Daniel J Corsi Mark Walker Daniel Krewski Steven Hawken Wenshan Li Taddele Kibret Zhong-Cheng Luo Ravi Retnakaran Shi Wu Wen
Introduction Recent studies have shown that the association between maternal hyperglycemia and future risk of diabetes had expanded from women with gestational diabetes (GDM) to those with hyperglycemia below the diagnostic thresholds for GDM. There is no published systematic review/meta-analysis summarizing whether and to what extent the association between maternal hyperglycemia and future risk of diabetes relates to the number of abnormal glucose values on the oral glucose tolerance test (OGTT) and the type of glucose challenge during pregnancy. This review was undertaken to fill this gap in the scientific literature.
Methods and analysis Comprehensive literature searches were performed in the following electronic databases: MEDLINE, EMBASE and CINAHL to retrieve relevant papers from inception to Jul 12, 2023. The Newcastle-Ottawa Scale (NOS) was used to assess their methodological quality. Meta analyses were conducted if the included studies were relatively homogeneous (tau-squared (τ2) <0.48). Subgroup analyses and sensitivity analyses were implemented for the robustness of the study results.
Results Nineteen studies were identified in this review, which covered a total of 628,510 women with glucose measured during pregnancy. Twelve studies were included in the meta-analysis. All these studies were rated as good/high quality, with a score of seven and above. The pooled OR of risk of diabetes among those with one abnormal value on the OGTT and at least two abnormal values, compared to normal OGTT/normal glucose challenge test (GCT) were 4.26 [2.71, 6.69] and 11.47 [7.88, 16.70] respectively. The pooled OR for the comparison between abnormal GCT with normal OGTT to normal GCT was 2.39 [1.56, 2.42].
Conclusion Elevated maternal glucose level was associated with increased risk of future diabetes, regardless of whether abnormal glucose values meet the diagnostic criteria for GDM, although women with at least two abnormal OGTT values (the commonly accepted diagnostic criteria for GDM) had the highest risk of diabetes in the future.