Review
Risk Factors for Type 2 Diabetes Among Women with Gestational Diabetes: A Systematic Review

https://doi.org/10.1016/j.amjmed.2008.09.034Get rights and content

Abstract

We conducted a systematic review of studies examining risk factors for the development of type 2 diabetes among women with previous gestational diabetes. Our search strategy yielded 14 articles that evaluated 9 categories of risk factors of type 2 diabetes in women with gestational diabetes: anthropometry, pregnancy-related factors, postpartum factors, parity, family history of type 2 diabetes, maternal lifestyle factors, sociodemographics, oral contraceptive use, and physiologic factors. The studies provided evidence that the risk of type 2 diabetes was significantly higher in women having increased anthropometric characteristics with relative measures of association ranging from 0.8 to 8.7 and women who used insulin during pregnancy with relative measures of association ranging between 2.8 and 4.7. A later gestational age at diagnosis of gestational diabetes, >24 weeks gestation on average, was associated with a reduction in risk of development of type 2 diabetes with relative measures of association ranging between 0.35 and 0.99. We concluded that there is substantial evidence for 3 risk factors associated with the risk of type 2 diabetes in women having gestational diabetes.

Section snippets

Methods

This study was part of a larger project commissioned by the Agency for Healthcare Research and Quality that was conducted by the Johns Hopkins University Evidence-based Practice Center9 to review the literature on the association of intrapartum management and postpartum follow-up of women with gestational diabetes with maternal and neonatal outcomes.

We used a systematic approach for searching the literature. We searched four databases: MEDLINE, EMBASE, The Cochrane Central Register of

Search Results

From the general search for the primary literature review, we retrieved 11,400 unique citations. After reviewing titles and abstracts, 552 were eligible for further review. After excluding 538 that did not meet eligibility criteria for this question, 14 articles were identified for review that evaluated potential risk factors for developing type 2 diabetes in women with prior gestational diabetes (Table 1, online).

Study Characteristics

The studies were conducted in diverse populations and included 10 studies in

Discussion

In this systematic review, we found substantial and consistent evidence that anthropometric measures of obesity, gestational age at gestational diabetes diagnosis, and method of glucose control were risk factors for the subsequent development of type 2 diabetes among women with previous gestational diabetes. The evidence was too weak to draw firm conclusions about other risk factors. No evidence on maternal lifestyle factors and risk of type 2 diabetes was found in this review, suggesting that

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    Funding: This research was supported by the Agency for Healthcare Research and Quality.

    Conflict of Interest: Each author represents and warrants that they have no financial affiliation or involvement with any commercial organization with potential financial interest in the subject or materials discussed in this manuscript except Sherita H. Golden, MD, MHS, who provides consulting services for Merck, Inc. and serves as a member of the US Clinical Diabetes Advisory Board.

    Authorship: Each author participated in the conception and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript.

    Prior Presentation: American Diabetes Association Scientific Sessions, June 2008.

    Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

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