北京大学第一医院张卓莉团队对妊娠期糖尿病与整体和类型特异性心脑血管疾病的关系进行了一项系统回顾和荟萃分析。这一研究成果于2022年9月21日发表在《英国医学杂志》上。

为了量化有妊娠期糖尿病史女性的总体和类型特异性心脑血管疾病以及静脉血栓栓塞的风险，研究组在PubMed、Embase和Cochrane图书馆中检索从成立到2021年11月1日的文献，并于2022年5月26日更新。筛选出关于妊娠期糖尿病与心脑血管疾病发病率之间相关性的观察研究，并进行系统回顾和荟萃分析。随机效应模型汇集的数据以风险比率（95%置信区间）表示。证据的确定性通过建议、评估、开发和评定分级进行评估。

研究组共纳入15项被评定为中度或重度偏倚风险的研究。在513324名妊娠期糖尿病妇女中，9507名患有心脑血管疾病。在800多万未患妊娠期糖尿病的对照妇女中，78895人患有心脑血管疾病。与无妊娠期糖尿病女性相比，有妊娠期糖尿病史的女性总体心脑血管疾病风险增加45%（风险比为1.45），其中心血管疾病风险增加72%（1.72），脑血管病风险增加40%（1.40）。妊娠期糖尿病妇女发生冠状动脉疾病（1.40）、心肌梗死（1.74）、心力衰竭（1.62）、心绞痛（2.27）、心血管手术（1.87）、中风（1.45）和缺血性中风（1.49）的风险增加。在妊娠期糖尿病患者中，静脉血栓栓塞的风险增加了28%（1.28）。

根据研究特征和校正分层的心脑血管疾病结局的亚组分析显示，不同地区（P=0.078）、研究设计（P=0.02）、数据来源（P=0.005）、以及研究质量（P=0.04）、吸烟校正（P=0.03）、体重指数（P=0.01）、社会经济状况（P=0.006）和合并症（P=0.05）等结局存在显著差异。然而，心脑血管疾病的风险降低了，但仅限于没有继发显性糖尿病的女性（所有妊娠期糖尿病：1.45，妊娠期糖尿病没有继发糖尿病：1.09），风险仍然显著。证据的确定性被判断为低质量或极低质量。

研究结果表明，妊娠期糖尿病与总体和类型特异性心脑血管疾病的风险增加相关，但这些疾病不能仅仅归因于传统的心血管风险因素或随后的糖尿病。

附：原文原文

Title: Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

Author: Wenhui Xie, Yu Wang, Shiyu Xiao, Lin Qiu, Yang Yu, Zhuoli Zhang

Issue&Volume: 2022/09/21

Abstract:

Objective To quantify the risk of overall and type specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes mellitus.

Design Systematic review and meta-analyses.

Data sources PubMed, Embase, and the Cochrane Library from inception to 1 November 2021 and updated on 26 May 2022.

Review methods Observational studies reporting the association between gestational diabetes mellitus and incident cardiovascular and cerebrovascular diseases were eligible. Data, pooled by random effects models, are presented as risk ratios (95% confidence intervals). Certainty of evidence was appraised by the Grading of Recommendations, Assessment, Development, and Evaluations.

Results 15 studies rated as moderate or serious risk of bias were included. Of 513324 women with gestational diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of more than eight million control women without gestational diabetes, 78895 had cardiovascular and cerebrovascular disease. Compared with women without gestational diabetes mellitus, women with a history of gestational diabetes mellitus showed a 45% increased risk of overall cardiovascular and cerebrovascular diseases (risk ratio 1.45, 95% confidence interval 1.36 to 1.53), 72% for cardiovascular diseases (1.72, 1.40 to 2.11), and 40% for cerebrovascular diseases (1.40, 1.29 to 1.51). Women with gestational diabetes mellitus showed increased risks of incident coronary artery diseases (1.40, 1.18 to 1.65), myocardial infarction (1.74, 1.37 to 2.20), heart failure (1.62, 1.29 to 2.05), angina pectoris (2.27, 1.79 to 2.87), cardiovascular procedures (1.87, 1.34 to 2.62), stroke (1.45, 1.29 to 1.63), and ischaemic stroke (1.49, 1.29 to 1.71). The risk of venous thromboembolism was observed to increase by 28% in women with previous gestational diabetes mellitus (1.28, 1.13 to 1.46). Subgroup analyses of cardiovascular and cerebrovascular disease outcomes stratified by study characteristics and adjustments showed significant differences by region (P=0.078), study design (P=0.02), source of data (P=0.005), and study quality (P=0.04), adjustment for smoking (P=0.03), body mass index (P=0.01), and socioeconomic status (P=0.006), and comorbidities (P=0.05). The risk of cardiovascular and cerebrovascular diseases was, however, attenuated but remained significant when restricted to women who did not develop subsequent overt diabetes (all gestational diabetes mellitus: 1.45, 1.33 to 1.59, gestational diabetes mellitus without subsequent diabetes: 1.09, 1.06 to 1.13). Certainty of evidence was judged as low or very low quality.

Conclusions Gestational diabetes mellitus is associated with increased risks of overall and type specific cardiovascular and cerebrovascular diseases that cannot be solely attributed to conventional cardiovascular risk factors or subsequent diabetes.

DOI: 10.1136/bmj-2022-070244

Source: https://www.bmj.com/content/378/bmj-2022-070244