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

Vounzoulaki, Elpida; Khunti, Kamlesh; Abner, Sophia; Tan, Bee K.; Davies, Melanie J.; Gillies, Clare

doi:10.1136/bmj.m1361

Cited by 698 publications

(581 citation statements)

References 54 publications

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“…Women with GDM are at higher risk of pre-eclampsia, more likely to have their labour induced and to give birth by caesarean section than women without GDM [ 4 ]. Their lifetime risk for developing type 2 diabetes and cardiovascular disease is high [ 5 , 6 ]. Infants born to women with GDM are more likely to be LGA than infants born to women without GDM, with increased risk of an operative birth, birth injuries, and significant neonatal morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Gestational diabetes mellitus (GDM) is a major and increasing health problem worldwide with rates varying depending on the population and diagnostic criteria used [ 1 , 2 ]. Defined by the World Health Organisation as “carbohydrate intolerance resulting in hyperglycaemia with onset or first recognition during pregnancy” [ 3 ], GDM has immediate health risks for the women and her offspring [ 4 ] as well as lifelong implications for their health [ 5 , 6 ], with adverse health effects continuing into the next generation [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Lower versus higher diagnostic criteria for the detection of gestational diabetes for reducing maternal and perinatal morbidity: study protocol for the GEMS randomised trial

Crowther

McCowan

Rowan

et al. 2020

BMC Pregnancy Childbirth

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Background Gestational diabetes mellitus (GDM) has lifelong implications for the woman and her infant. Treatment reduces adverse maternal and perinatal outcomes although uncertainty remains about the optimal diagnostic criteria. The GEMS Trial aims to assess whether detection and treatment of women with GDM using the lower International Association of Diabetes in Pregnancy Study Groups diagnostic criteria compared with the higher criteria recommended in New Zealand reduces infant morbidity without increasing maternal morbidity. Methods GEMS is a multicentre, randomised trial. Women with a singleton pregnancy at 24 to 34 weeks’ gestation are eligible who give written informed consent. Women are randomly allocated to the Lower Criteria Group or the Higher Criteria Group. Women with a normal OGTT by their allocated criteria receive routine care (Higher criteria: fasting plasma glucose < 5.5 mmol/L, AND 2 hour < 9.0 mmol/L; Lower criteria: fasting plasma glucose < 5.1 mmol/L, AND 1 hour < 10.0 mmol/L, AND 2 hour < 8.5 mmol/l). Women with GDM on OGTT by their allocated criteria receive standard care for GDM (Higher criteria: fasting plasma glucose ≥ 5.5 mmol/L, OR 2 hour ≥ 9.0 mmol/L; Lower criteria: fasting plasma glucose ≥ 5.1 mmol/L, OR 1 hour ≥ 10.0 mmol/L, OR 2 hour ≥ 8.5 mmol/L). The primary outcome is large for gestational age (birth weight > 90th centile). Secondary outcomes for the infant include a composite of serious outcomes, gestational age, anthropometry, Apgar score < 4 at 5 minutes, lung disease, use of respiratory support, hypoglycaemia, hyperbilirubinaemia, infection, and encephalopathy; and for the woman, a composite of serious outcomes, preeclampsia, induction of labour, mode of birth, weight gain, postpartum haemorrhage and infectious morbidity. A study with 4,158 women will detect an absolute difference of 2.9% in the proportion of large for gestational age infants from 10.0% using the lower criteria to 12.9% with the higher criteria. Discussion The GEMS Trial will provide high-level evidence relevant for clinical practice. If use of the lower diagnostic criteria results in significantly fewer large for gestational age infants and/or improves maternal and perinatal outcomes these criteria should be recommended for diagnosis of gestational diabetes. Trial registration Australian New Zealand Clinical Trials Registry registration number ACTRN12615000290594. Date registered: 27th March 2015.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lower versus higher diagnostic criteria for the detection of gestational diabetes for reducing maternal and perinatal morbidity: study protocol for the GEMS randomised trial

Crowther

McCowan

Rowan

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…These reports are in line with our ndings. In the other hand, many previous systematic review and metaanalysis as well as cohort studies reported that higher FBG levels could increase the risk of GDM and type 2 diabetes in later life [47][48][49][50][51]. Therefore, higher preconception exposure to PMs might increase the risk of type 2 diabetes in these participants in later life.…”

Section: Available Evidencementioning

confidence: 96%

Preconception air pollution exposure and glucose tolerance in healthy pregnant women in a middle-income country

Najafi

Zareie

Gohari

et al. 2020

Preprint

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Background: Preconception exposure to air pollution has been associated with glucose tolerance during pregnancy. However, the evidence in low and middle-income countries (LMICs) is under debate yet. Therefore, this study aimed to assess the relationship between exposure to ambient particulate matter (PM) and traffic indicators with glucose tolerance in healthy pregnant women in Sabzevar, Iran (2019).Methods: Two-hundred and fifty healthy pregnant women with singleton pregnancies and 24-26 weeks of gestations participated in our study. Land use regression (LUR) models were applied to estimate the annual mean of PM1, PM2.5 and PM10 at the residential address. Traffic indicators, including proximity of women to major roads as well as total streets length in 100, 300 and 500m buffers around the home were calculated using the street map of Sabzevar. The oral glucose tolerance test (OGTT) was used to assess glucose tolerance during pregnancy. Multiple linear regression adjusted for relevant covariates was used to estimate the association of fasting blood glucose (FBG), 1-h and 2-h post-load glucose with PMs and traffic indicators.Results: Exposure to PM1, PM2.5 and PM10 was significantly associated with higher FBG concentration. Higher total streets length in a 100 m buffer was associated with higher FBG and 1-h glucose concentrations. An interquartile range (IQR) increase in proximity to major roads was associated with a decrease of 3.42 mg/dL (95% confidence interval (CI): -4.47, -2.37, P-value < 0.01) in FBG level and -4.65 mg/dL (95% CI: -8.03, -1.26, P-value < 0.01) decrease in 1-h post-load glucose.Conclusion: We found that higher preconception exposure to air pollution was associated with higher FBG and 1-h glucose concentrations during pregnancy.

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“…In recent decades, the prevalence of GDM has increased by more than 30% in several countries, including developing countries [ 6 , 7 ]. Women with a history of GDM have a 9-fold increased risk of developing future T2DM [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Feasibility and Preliminary Efficacy of an eHealth Lifestyle Program in Women with Recent Gestational Diabetes Mellitus: A Pilot Study

Rollo

Baldwin

Hutchesson

et al. 2020

IJERPH

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Self-administered eHealth interventions provide a potential low-cost solution for reducing diabetes risk. The aim of this pilot randomised controlled trial (RCT) was to evaluate the feasibility, including recruitment, retention, preliminary efficacy (primary outcome) and acceptability (secondary outcome) of the “Body Balance Beyond” eHealth intervention in women with previous gestational diabetes mellitus (GDM). Women with overweight/obesity who had recent GDM (previous 24 months) were randomised into one of three groups: 1) high personalisation (access to “Body Balance Beyond” website, individual telehealth coaching via video call by a dietitian and exercise physiologist, and text message support); 2) low personalisation (website only); or 3) waitlist control. To evaluate preliminary efficacy, weight (kg), glycosylated hemoglobin, type A1C (HbA1c), cholesterol (total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), diet quality and moderate–vigorous physical activity were analysed at baseline and at 3 and 6 months using generalised linear mixed models. To investigate acceptability, process evaluation was conducted at 3 and 6 months. Of the 327 potential participants screened, 42 women (mean age 33.5 ± 4.0 years and BMI 32.4 ± 4.3 kg/m2) were randomised, with 30 (71%) completing the study. Retention at 6 months was 80%, 54% and 79% for high personalisation, low personalisation and waitlist control, respectively (reasons: personal/work commitments, n = 4; started weight-loss diet, n = 1; pregnant, n = 1; resources not useful, n = 1; and not contactable, n = 5). No significant group-by-time interactions were observed for preliminary efficacy outcomes, with the exception of HDL cholesterol, where a difference favoured the low personalisation group relative to the control (p = 0.028). The majority (91%) of women accessed the website in the first 3 months and 57% from 4–6 months. The website provided useful information for 95% and 92% of women at 3 and 6 months, respectively, although only a third of women found it motivating (30% and 25% at 3 and 6 months, respectively). Most women agreed that the telehealth coaching increased their confidence for improving diet (85%) and physical activity (92%) behaviours, although fewer women regarded the text messages as positive (22% and 31% for improving diet and physical activity, respectively). The majority of women (82% at 3 months and 87% at 6 months) in the high personalisation group would recommend the program to other women with GDM. Recruiting and retaining women with a recent diagnosis of GDM is challenging. The “Body Balance Beyond” website combined with telehealth coaching via video call is largely acceptable and useful for women with recent GDM. Further analysis of the effect on diabetes risk reduction in a larger study is needed.

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

Cited by 698 publications

References 54 publications

Lower versus higher diagnostic criteria for the detection of gestational diabetes for reducing maternal and perinatal morbidity: study protocol for the GEMS randomised trial

Lower versus higher diagnostic criteria for the detection of gestational diabetes for reducing maternal and perinatal morbidity: study protocol for the GEMS randomised trial

Preconception air pollution exposure and glucose tolerance in healthy pregnant women in a middle-income country

The Feasibility and Preliminary Efficacy of an eHealth Lifestyle Program in Women with Recent Gestational Diabetes Mellitus: A Pilot Study

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