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Diabetes Distilled: Women with previous gestational diabetes at higher risk of type 2 diabetes than previously thought

Pam Brown
Women with a history of gestational diabetes (GDM) have an almost 10-times greater risk of developing type 2 diabetes than women who have normal glucose during pregnancy, according to this systematic review and meta-analysis of observational studies. Although previous GDM has long been recognised as a risk factor for the development of type 2 diabetes, this analysis included newer evidence including longer studies, and demonstrated a higher risk than had previously been recognised. Intensive lifestyle change and annual monitoring are therefore important after a pregnancy complicated by GDM, in order to reduce the risk of type 2 diabetes and ensure it is identified early.

In this meta-analysis of 20 observational studies including 1.3 million women, of whom nearly 68 000 had gestational diabetes, the relative risk of development of type 2 diabetes was 9.51 in those with a history of gestational diabetes (GDM) versus those without. The study also explored ethnic variation in progression to type 2 diabetes but the differences were not statistically significant.

This is higher than the previously estimated risk. Diagnostic criteria for GDM and type 2 diabetes have changed over the last decade, and recent studies of progression, some of longer duration, have been published; therefore, this systematic review and meta-analysis is timely.

The prevalence of GDM has increased in recent years, attributed to increasing obesity levels and women delaying pregnancy until later age. Previous studies have identified a cumulative incidence of type 2 diabetes post-GDM varying between 2.6% to >70% depending on the duration of follow-up, with the greatest risk in the first 5 years postpartum.

Only around 50% of women with GDM attend for postpartum screening in the UK currently; thus, diagnosis of progression to type 2 diabetes may be delayed. The authors hope their study will improve awareness amongst both healthcare professionals and women with previous GDM of the importance of annual screening, changes to diet and lifestyle, and consideration of drug therapy to reduce the very significant risk of developing type 2 diabetes. It is hoped that future studies will explore how to improve uptake of screening and the effectiveness of preventative options.

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