Author(s)

Ziyu Li, Liru Cao, Luyi Sen

Corresponding Author

Luyi Sen

Abstract

The incidence of gestational diabetes mellitus (GDM) is increasing every year. Many pregnant women with GDM experience recurrence in subsequent pregnancies. In addition, GDM poses a risk to both the mother and the child, and GDM is an important risk factor for type 2 diabetes(T2DM), so it is necessary to find risk factors for recurrence of GDM. This meta-analysis aims to identify the risk factors associated with recurrence of GDM, to reduce the recurrence rate and to improve the prognosis of patients. This meta-analysis was conducted by a systematic search of the PubMed, Cochrane, Embase and Web of science libraries for original eligible studies published in English up to October 2021. All search results were examined against our inclusion and exclusion criteria. We calculated pooled odds ratios (ORs) or standardised mean differences (SMDs) with their corresponding 95% confidence intervals (CIs) to assess the impact of included risk factors on GDM recurrence. A total of 15 studies involving 9276 patients with GDM published by October 2021 were ultimately included. The results of our meta-analysis showed that recurrence of GDM was associated with family history of diabetes (OR=1.68, 95% CI: 1.37-2.07, p<0.001), insulin therapy at index pregnancy (OR=2.52, 95% CI: 1.99-3.19, p<0.001), maternal age at index pregnancy (SMD=1.30. 95% CI: 0.22-0.38, P<0. 001), pregnancy BMI at index pregnancy (SMD=1.23, 95%CI:0.37-2.09, P=0.005), parity at index pregnancy (SMD=0.44, 95%CI:0.02-0.98, P<0.001), fasting glucose level at index pregnancy (SMD=0.36, 95%CI:0.18-0.53, P<0.001), HbA1c level at index pregnancy (SMD= 0.47, 95% CI:0.05-0.88, P=0.03) and gestational interval (SMD=0.34, 95% CI:0.11-0.57, P=0.004). Recurrence of GDM was not associated with gestational hypertension at index pregnancy (OR=2.53, 95% CI: 0.53-12.18, P=0.25), pre-pregnancy weight at index pregnancy (SMD=0.3, 95% CI: -0.13-0.73, P=0.17), weight gained during pregnancy at index pregnancy (SMD=-0.11, 95% CI: -0.33 -0.10, P=0.72), and neonatal birth weight at index pregnancy (SMD=-0.03, 95% CI: -0.24-0.18, P=0.78). Meta-analysis showed that family history of diabetes, age, severe insulin resistance in pregnant women and long pregnancy intervals were risk factors for recurrence of GDM. However, the impact of other potential risk factors, including gestational hypertension, on the recurrence of GDM requires further study. Although maternal pre-pregnancy weight and fetal birth weight at index pregnancy are not associated with the recurrence of GDM, BMI, which reflects obesity, is associated with the recurrence of GDM.

Keywords

Gestational Diabetes Mellitus (GDM), Risk Factors Analysis, Meta-Analysis Methodology