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 1 332 373 individuals (67 956 women with GDM and 1 264 417 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. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123079.

中文翻译：

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已知有妊娠糖尿病病史的女性进展为 2 型糖尿病：系统评价和荟萃分析。

目的 估计和比较妊娠期糖尿病 (GDM) 女性和健康对照组的 2 型糖尿病 (T2DM) 进展率。设计系统回顾和荟萃分析。数据来源 Medline 和 Embase 于 2000 年 1 月至 2019 年 12 月期间以英文发表并针对人类进行的研究。选择研究的资格标准 调查进展为 T2DM 的观察性研究。纳入标准是产后随访至少 12 个月、基于医生的糖尿病诊断、T2DM 报告为单独的结果，而不是与空腹血糖受损或糖耐量受损相结合，以及对 GDM 患者和控制组。结果 这项荟萃分析对 20 项研究进行了评估，共评估了 1 332 373 名个体（67 956 名 GDM 女性和 1 264 417 名对照组）。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。估计了 GDM 参与者和对照组之间 T2DM 发病率的汇总相对风险。研究之间异质性的原因通过预先设定的亚组和荟萃回归分析进行调查。通过漏斗图评估发表偏倚，总体而言，研究被认为具有低偏倚风险（P=0.58 和 P=0.90）。既往 GDM 女性的 T2DM 总体相对风险几乎是健康对照组的 10 倍（9.51，95% 置信区间 7.14 至 12.67，P<0.001）。在既往患有 GDM 的女性人群中，T2DM 的累积发病率为 16。混合种族女性为 46%（95% 置信区间 16.16% 至 16.77%），以非白人为主的人群为 15.58%（13.30% 至 17.86%），白人为 9.91%（9.39% 至 10.42%） . 这些差异在亚组之间没有统计学意义（白人 v 混合人群， P = 0.26；白人 v 非白人群体， P = 0.54）。Meta回归分析表明，研究效应大小与平均研究年龄、体重指数、发表年份和随访时间无显着相关性。结论 有 GDM 病史的女性发生 T2DM 的风险似乎比血糖正常妊娠的女性高近 10 倍。这种风险的严重性凸显了干预以预防 T2DM 发作的重要性，尤其是在怀孕后的最初几年。