英国莱斯特大学Elpida Vounzoulaki研究组分析了妊娠期糖尿病史女性进展为2型糖尿病的风险。相关论文于2020年5月13日发表在《英国医学杂志》上。

为了评估和比较妊娠期糖尿病（GDM）和健康对照组女性的2型糖尿病（T2DM）进展率，研究组在Medline和Embase数据库中检索2000年1月至2019年12月间关于T2DM进展的研究，GDM产后至少随访12个月，并对符合条件的研究进行系统回顾和荟萃分析。

该荟萃分析共纳入20项研究，评估了1332373名女性，包括67956名GDM女性和1264417健康女性。通过随机效应荟萃分析模型汇总数据，并使用I2统计量评估异质性，估计GDM患者与对照组之间T2DM发病率的合并相对风险。各研究间异质性的原因已通过预先指定的亚组和荟萃回归分析进行了调查。

通过漏斗图评估出版偏倚，总体来说偏倚风险较低。曾患有GDM的女性患T2DM的总体相对风险几乎比健康对照者高10倍，差异显著。在患有GDM的人群中，混合种族女性的T2DM累积发病率为16.46％，非白人女性为15.58％，白人女性为9.91％。亚组之间的差异无统计学意义。荟萃分析显示，研究效应规模与平均研究年龄、体重指数、发表年份和随访时间均不相关。

总之，有GDM病史的女性患T2DM的风险似乎比妊娠期血糖正常的女性高近10倍，应在孕早期及时干预。

附：英文原文

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

Author: Elpida Vounzoulaki, Kamlesh Khunti, Sophia C Abner, Bee K Tan, Melanie J Davies, Clare L Gillies

Issue&Volume: 2020/05/13

Abstract: Objective To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.

Design Systematic review and meta-analysis.

Data sources Medline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.

Eligibility criteria for selecting studies Observational 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.

Results This meta-analysis of 20 studies assessed a total of 1332373 individuals (67956 women with GDM and 1264417 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.

Conclusions Women 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.

DOI: 10.1136/bmj.m1361

Source: https://www.bmj.com/content/369/bmj.m1361