Risk of Developing Type 2 Diabetes Mellitus in South Asian Women with History of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

Background: Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) represent two different components of the spectrum of diabetes mellitus (DM). Women with GDM have a high chance of developing T2DM in later life and this relative risk depends on a number of factors including ethnicity. Aim: To compare and estimate the risk of developing T2DM in South Asian women with a history of GDM compared to those without a history of GDM. Methods: This is a systematic review of PubMed and MEDLINE articles reporting the progression of GDM to T2DM that were published in English from 2000 to 2020. We performed meta-analysis to calculate risk ratios (RR). Results: We selected 6 studies considering the inclusion and exclusion criteria after sorting 25 full-text articles. Of the 44165 South Asian women assessed, 3095 had GDM and 41070 were without GDM. 995 women in GDM group and 1525 women in non-GDM group had developed T2DM. The RR of women with GDM over non-GDM in developing T2DM was 10.81 (95% confidence interval (CI): 7.61–15.35) suggesting that women with GDM are at 10.81 times more risk of developing T2DM than non-GDM. The cumulative incidence of T2DM in GDM group was 17.34% at 5 years of follow-up and 33% at more than 10 years of follow-up. Conclusion: The risk of developing T2DM in later life is higher in South Asian women with GDM than without GDM. Therefore, lifestyle and pharmacological interventions, patient communication, timely screening, and long-term follow-up of GDM patients are important to reduce the risk.

Overt Diabetes in Pregnancy

“…The risk for postpartum dysglycemia and abnormal cardiometabolic profile is reportedly higher among women with GDM belonging to South Asian ethnicity [32][33][34][35][36][37][38][39][40]. The distinct South Asian phenotype, characterized by increased visceral fat, lower muscle mass, and accelerated beta cell decline, plays an important role towards this observation [41,42].…”

Prevalence and Factors Associated with Postpartum Glucose Intolerance Following Gestational Diabetes Mellitus in Malaysia: A Narrative Review

“…Sociodemographic factors including maternal age, lower educational level and being working mothers were associated with postpartum glucose intolerance. Advanced maternal age was an independent predictor of future T2D following GDM pregnancies in several Asian and Caucasian cohorts (Rayanagoudar et al, 2016;Gadve et al, 2021). The landscape of female autonomy is changing, with delayed childbearing becoming more common in developed countries as the priority has shifted to pursuing educational and career goals before rearing a family (Sauer, 2015).…”

“…In Malaysian women of reproductive age (18 -49 years old), the prevalence of overall raised blood glucose was 4.0% to 25.2% (Institute for Public Health, 2019). However, there was no local nationwide data on T2D prevalence in women post-GDM, despite women post-GDM having a 10-fold risk of developing T2D compared to women with normoglycemic pregnancies (Vounzoulaki et al, 2020;Gadve et al, 2021). Up to 31% parous women with T2D had a previous diagnosis of GDM (Cheung & Byth, 2003).…”

“…Diabetes genes and lifestyle behaviour of Asian populations may widely differ from their Caucasion counterpart (Hu et al, 2011;Gujral et al, 2013;Norimah et al, 2008). There are limited reviews discussing on the prevalence and factors associated with postpartum glucose intolerance in Asian women post-GDM (Nouhjah et al, 2007;Gadve et al, 2021), and none in the Malaysian population. Hence, the current review may be useful to identify strategies for public health interventions for women post-GDM in this specific Asian population.…”

Metabolic Drivers of Dysglycemia in Pregnancy: Ethnic-Specific GWAS of 146 Metabolites and 1-Sample Mendelian Randomisation Analyses in a UK Multi-Ethnic Birth Cohort

“…Globally, GDM is the most common pregnancy complication, affecting up to one in every seven births; however, its prevalence varies between ethnic groups, with South Asian (SA) women at 3-fold greater risk compared to white European (WE) women, irrespective of BMI and country of residence [5,7]. Furthermore, SA women are more likely to develop T2D in later life following a GDM diagnosis [8].…”