The Relationship Between Gestational Diabetes and the Risk of Cancer: A Systematic Review

Abstract

Gestational diabetes mellitus (GDM) is one of the most common endocrine disorders to occur during pregnancy due to the increase in circulating human placental lactogen (hPL) and possible beta-cell sensitivity. While GDM can be managed either with diet and exercise or pharmacological interventions, it is associated with significant maternal and neonatal complications. Maternal complications include short-and long-term conditions such as pre-eclampsia, preterm birth, arrest of labor, future development of type 2 diabetes mellitus (T2DM), and cardiovascular disorders. Neonates can develop hypoglycemia and hypocalcemia and have a large gestational age (LGA). New research has also highlighted another possible long-term complication for both mothers and offspring, which is the development of cancer. Cancer has various types of progression, but most cause systemic symptoms leading to a reduced quality of life. Cancer can be terminal and can affect the majority of the population; thus, significant effort is being employed to try and reduce its occurrence. This systematic review was conducted with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, ScienceDirect, and ProQuest databases. Initially, 136,019 publications were identified. Through the screening process, a total of 27 publications were finalized within the scope of this paper.Most studies observing maternal cancer with a history of GDM found that there was an association between the increased risk of cancer and GDM. Specifically, these studies identified the association of GDM with breast, ovarian, cervical, and uterine cancer, as well as other non-reproductive organs such as the thyroid and pancreas. Cancer development in the offspring also presented an association with mothers who developed GDM. The most prevalent cancer evaluated was leukemia, and it was specifically associated with a maternal history of GDM. With the consistent rise in the incidence of cancer, any attempts to reduce its development are imperative to assess. While GDM is essentially a temporary condition that resolves following pregnancy in most patients, the possibility of contributing to future conditions years after its occurrence creates a sense of urgency and necessity to reduce the incidence of GDM. Researchers should be able to identify other unknown biomarkers that contribute to the development of cancer in mothers who experienced GDM as well as their infants.

Gestational Diabetes Mellitus and Its Correlation in the Development of Pancreatic Cancer: A 10-Year Systematic Review

“…For the Cochrane risk bias tool, three systematic reviews and meta-analysis studies were included: Tong G.-X., Wang Y. and Slouha E [29,32,35]. Six domains were used to classify and rate the context of each study with the following information, random sequence generation, allocation concealment, participant and personnel blinding, outcome assessment blinding, incomplete outcome data and biased reporting and further biased sources.…”

“…The study of Tong G.-X [29] received the highest score of the three, which was 6, as it included all relevant information. The study of Slouha E. [35] received a score of 5, and the study of Wang Y. [32] received the lowest score of 2 (Table 6).…”

“…Firstly, three out of the eight studies, namely Slouha E, Peng et al and Wang Y, [31,32,35], concluded that increased maternal age increases the risk of development of GDM, and four out of eight studies, namely Slouha E, Peng et al, Quaresima, Wang Y and Tong G.-X., [29,31,33,35], stated that higher maternal weight and obesity are contributors to higher risks in the development of GDM. Based on the studies retrieved, it can be stated that the reason for this correlation might be due to higher nutrient intake, greater circulating adipokine and greater oxidative stress among pregnant women in advanced maternal stage [36].…”

“…Based on the studies retrieved, it can be stated that the reason for this correlation might be due to higher nutrient intake, greater circulating adipokine and greater oxidative stress among pregnant women in advanced maternal stage [36]. The studies of Wang Y. and Slouha E. [32,35], stated that except for obesity and increased maternal age, PCOS as well as family history of T2DM, prediabetes and previous history of fetal death can also play an important role in the development of GDM [32].…”

“…Moving on, the study of Choudhury AA [34] reports that patients who have been diagnosed with DM are more likely to develop cancers such as pancreatic, colon, liver, kidney and bladder cancer, and a high linkage of GDM and development of cancer can be observed. Lastly, the study of Slouha E [35] states that women with GDM have higher chances of developing breast, ovarian, cervical and uterine cancer, as well as cancer in non-reproductive organs, like the thyroid and pancreas.…”