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 513 324 women with gestational diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of more than eight million control women without gestational diabetes, 78 895 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. Study specific summary data are available from the corresponding author (zhuoli.zhang@126.com).

中文翻译：

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妊娠期糖尿病与整体和类型特异性心脑血管疾病的关系：系统评价和荟萃分析

目的量化有妊娠糖尿病病史的女性发生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。设计系统回顾和荟萃分析。数据来源 PubMed、Embase 和 Cochrane 图书馆，从成立到 2021 年 11 月 1 日，并于 2022 年 5 月 26 日更新。审查方法 报告妊娠期糖尿病与心脑血管疾病事件之间关联的观察性研究符合条件。由随机效应模型汇总的数据以风险比（95% 置信区间）表示。证据的确定性是通过对建议、评估、发展和评估的分级来评估的。结果 纳入了 15 项被评为中度或重度偏倚风险的研究。513324名妊娠糖尿病妇女中，9507名患有心脑血管疾病。在超过 800 万没有妊娠糖尿病的对照女性中，78 895 人患有心脑血管疾病。与没有妊娠糖尿病的女性相比，有妊娠糖尿病病史的女性整体心脑血管疾病风险增加 45%（风险比 1.45，95% 置信区间 1.36 至 1.53），心血管疾病风险增加 72%（1.72， 1.40 至 2.11），脑血管疾病为 40%（1.40，1.29 至 1.51）。患有妊娠期糖尿病的女性患冠状动脉疾病（1.40、1.18 至 1.65）、心肌梗塞（1.74、1.37 至 2.20）、心力衰竭（1.62、1.29 至 2.05）、心绞痛（2.27、1.79 至 2.87）的风险增加, 心血管手术（1.87、1.34 至 2.62）、中风（1.45、1.29 至 1.63）和缺血性中风（1.49、1.29 至 1.71）。观察到既往患有妊娠期糖尿病的女性发生静脉血栓栓塞的风险增加了 28%（1.28，1.13 至 1.46）。按研究特征和调整分层的心脑血管疾病结局亚组分析显示，不同地区（P=0.078）、研究设计（P=0.02）、数据来源（P=0.005）和研究质量（P=0.04）存在显着差异、吸烟 (P=0.03)、体重指数 (P=0.01) 和社会经济地位 (P=0.006) 和合并症 (P=0.05) 的调整。然而，心血管和脑血管疾病的风险有所降低，但在仅限于未发展为随后的明显糖尿病的女性（所有妊娠糖尿病：1.45，1.33 至 1.59，无后续糖尿病的妊娠糖尿病：1.09、1.06 至 1.13）。证据的质量被判定为低或极低质量。结论 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，这些疾病不能仅仅归因于传统的心血管危险因素或随后的糖尿病。研究具体汇总数据可从通讯作者（zhuoli.zhang@126.com）处获得。结论 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，这些疾病不能仅仅归因于传统的心血管危险因素或随后的糖尿病。研究具体汇总数据可从通讯作者（zhuoli.zhang@126.com）处获得。结论 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，这些疾病不能仅仅归因于传统的心血管危险因素或随后的糖尿病。研究具体汇总数据可从通讯作者（zhuoli.zhang@126.com）处获得。