Postpartum screening practices, progression to abnormal glucose tolerance and its related risk factors in Asian women with a known history of gestational diabetes: A systematic review and meta-analysis

Nouhjah, Sedigheh; Shahbazian, Hajieh; Amoori, Neda; Jahanfar, Shayesteh; Shahbazian, Nahid; Jahanshahi, Alireza; Cheraghian, Bahman

doi:10.1016/j.dsx.2017.05.002

Cited by 40 publications

(34 citation statements)

References 37 publications

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“…Some of our included studies, however, involved both women diagnosed with the criteria used before 1997, and women diagnosed with the revised criteria 313435363841434849. Additionally, previous systematic reviews have focused on a specific ethnic group,14 or included studies with short term follow-up (≤6 months) 1214. Kim et al also showed a higher cumulative incidence of T2DM in the first five postpartum years, which then seemed to plateau in further years 12.…”

Section: Discussionmentioning

confidence: 99%

“…In 2009, Bellamy et al showed a sevenfold higher risk of T2DM in patients with GDM in comparison with healthy controls (relative risk 7.43, 95% confidence interval 4.79 to 11.51) 13. A further systematic review evaluated the rate of compliance with screening, and the prevalence of T2DM in Asian women, reporting incidences of between 2.8% and 58% in women with previous GDM 14…”

Section: Introductionmentioning

confidence: 99%

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Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

691

476

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ObjectiveTo estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.DesignSystematic review and meta-analysis.Data sourcesMedline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.Eligibility criteria for selecting studiesObservational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.ResultsThis meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.ConclusionsWomen with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.Systematic review registrationPROSPERO CRD42019123079.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

691

476

View full text Add to dashboard Cite

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“…Current ndings showed that the incidence of postpartum glucose abnormalities included pre-diabetes (23 vs. 17.2%) and diabetes (3.3 vs. 3.1%) was not signi cantly different between GDM after ART and spontaneous conception. In a recent meta-analysis, the prevalence of pre-diabetes and diabetes was respectively 3.9-50.9% and 2.8-58% in Asian women with gestational diabetes within 4 weeks to 15 years postpartum based on the length of follow-up [21]. Considerable evidences propose that beta-cell dysfunction likely contributes to increase the risk of glucose intolerance in the rst year postpartum in GDM women [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Early Post-partum Glucose Intolerance, Metabolic Syndrome and Gestational Diabetes Mellitus Determinants After Assisted Conception: A Prospective Cohort Study

Kouhkan

Hosseini

Baradaran

et al. 2020

Preprint

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Background: This study aimed to determine the prevalence of postpartum metabolic syndrome (MetS), glucose intolerance and other determinants, 6-12 weeks postpartum in women with assisted reproduction technology conception gestational diabetes mellitus diagnosis (ART-GDM) compared to women with spontaneous conception and GDM diagnosis (SC-GDM).Methods: In this prospective cohort study, two groups consisted of 62 ART-GDM and 64 SC-GDM singleton pregnant women were followed 6-12 weeks after delivery for postpartum MetS. Fasting glucose, 75-g 2-h OGTT and lipid profile were assessed. Waist and hip circumference, and systolic and diastolic blood pressures (BP) were measured at post- partum. Clinical, para clinical and obstetric data were recorded from registry offices. The prevalence of MetS and glucose intolerance were determined. Predictors of Mets and glucose intolerance were determined by logistic regression. Results: The prevalence of postpartum MetS was 20.8% in ART-GDM women and 10.9% in SC-GDM, P=0.123). Mean postpartum BMI and systolic BP were significantly higher in the ART-GDM group (P=0.016 and P=0.027, respectively). Adverse pregnancy outcomes were significantly higher in the ART-GDM group. Postpartum glucose intolerance prevalence did not vary significantly between the groups. Family history of diabetes was a predictive factor for postpartum MetS and glucose intolerance 6-12 weeks after delivery.Conclusions: Early postpartum MetS and glucose intolerance prevalence after assisted conception did not vary significantly; however, postpartum BMI and systolic BP were significantly higher in the ART-GDM group. Lifestyle modification program and long-term health care of ART women with GDM diagnosis can be recommended. Further studies with larger sample size and longer follow-up are necessary to verify our findings.

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“…In Asia, it is reported that the incidence of diabetes is rapidly increasing and that no less than 60% of the patients diagnosed with diabetes is alive . Diabetes is one of the most common diseases among Chinese population which has been specially analysed in Chinese reports .…”

Section: Introductionmentioning

confidence: 99%

MicroRNA‐351 eases insulin resistance and liver gluconeogenesis via the PI3K/AKT pathway by inhibiting FLOT2 in mice of gestational diabetes mellitus

Chen

Liu

Peng

2019

J Cellular Molecular Medi

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Gestational diabetes mellitus (GDM) is known as different degree glucose intolerance that is initially identified during pregnancy. MicroRNAs (miRs) may be a potential candidate for treatment of GDM. Herein, we suggested that miR‐351 could be an inhibitor in the progression of GDM via the phosphoinositide 3‐kinase/protein kinase B (PI3K/AKT) pathway. Microarray analysis was used to identify differentially expressed genes and predict miRs regulating flotillin 2 (FLOT2). Target relationship between miR‐351 and FLOT2 was verified. Gestational diabetes mellitus mice were treated with a series of mimic, inhibitor and small interfering RNA to explore the effect of miR‐351 on insulin resistance (IR), cell apoptosis in pancreatic tissues and liver gluconeogenesis through evaluating GDM‐related biochemical indexes, as well as expression of miR‐351, FLOT2, PI3K/AKT pathway‐, IR‐ and liver gluconeogenesis‐related genes. MiR‐351 and FLOT2 were reported to be involved in GDM. FLOT2 was the target gene of miR‐351. Gestational diabetes mellitus mice exhibited IR and liver gluconeogenesis, up‐regulated FLOT2, activated PI3K/AKT pathway and down‐regulated miR‐351 in liver tissues. Additionally, miR‐351 overexpression and FLOT2 silencing decreased the levels of FLOT2, phosphoenolpyruvate carboxykinase, glucose‐6‐phosphatase, fasting blood glucose, fasting insulin, total cholesterol, triglyceride, glyeosylated haemoglobin and homeostasis model of assessment for IR index (HOMA‐IR), extent of PI3K and AKT phosphorylation, yet increased the levels of HOMA for islet β‐cell function, HOMA for insulin sensitivity index and glucose transporter 2 expression, indicating reduced cell apoptosis in pancreatic tissues and alleviated IR and liver gluconeogenesis. Our results reveal that up‐regulation of miR‐351 protects against IR and liver gluconeogenesis by repressing the PI3K/AKT pathway through regulating FLOT2 in GDM mice, which identifies miR‐351 as a potential therapeutic target for the clinical management of GDM.

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Postpartum screening practices, progression to abnormal glucose tolerance and its related risk factors in Asian women with a known history of gestational diabetes: A systematic review and meta-analysis

Cited by 40 publications

References 37 publications

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

WITHDRAWN: Early Post-partum Glucose Intolerance, Metabolic Syndrome and Gestational Diabetes Mellitus Determinants After Assisted Conception: A Prospective Cohort Study

MicroRNA‐351 eases insulin resistance and liver gluconeogenesis via the PI3K/AKT pathway by inhibiting FLOT2 in mice of gestational diabetes mellitus

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