Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis

Wu, Pensee; Shing Kwok, Chun; Haththotuwa, Randula; Kotronias, Rafail A.; Babu, Aswin; Fryer, Anthony A.; Myint, Phyo K.; Chew-Graham, Carolyn A.; Mamas, Mamas A.

Abstract

Aims/hypothesis: Pre-eclampsia is a pregnancy-specific multi-system disorder and a state of physiological insulin resistance. Our aim is to systematically evaluate and quantify the evidence on the relationship between pre-eclampsia and the future risk of diabetes. Methods: We conducted a systematic review and meta-analysis of studies that evaluated diabetes in women with and without pre-eclampsia. We performed a systematic search of MEDLINE and EMBASE to identify relevant studies. Independent double data extractions were conducted by four reviewers. Random effects meta-analysis was used to estimate the risk of future diabetes following pre-eclampsia. Results: Twenty-one studies were identified with over 2.8 million women including >72,000 women with pre-eclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that pre-eclampsia was independently associated with an increased risk of future diabetes (risk ratio (RR) 2.37, 95% CI 1.89, 2.97). This risk appeared in studies that followed up women from <1 year (RR 1.97, 95% CI 1.35, 2.87) and persisted to over 10 years post-partum (RR 1.95, 95% CI 1.28, 2.97). After adjusting for BMI or gestational diabetes, pre-eclampsia was linked with an increased risk of future diabetes (RR 2.38, 95% CI 1.74, 3.24) or (RR 2.36, 95% CI 1.94, 2.88), respectively. Conclusions/interpretation: Pre-eclampsia is independently associated with a two-fold increase in future diabetes. Our study highlights the importance of clinical risk assessment for the future development of diabetes in women with pre-eclampsia. We recommend detailed evaluation of a screening programme for diabetes in this high-risk population.

• Journal Article Type: Article
• Acceptance Date: Aug 4, 2016
• Online Publication Date: Sep 19, 2016
• Publication Date: 2016-12
• Publicly Available Date: May 26, 2023
• Journal: Diabetologia
• Print ISSN: 0012-186X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Pages: 2518-2526
• DOI: https://doi.org/10.1007/s00125-016-4098-x
• Keywords: Diabetes mellitus, Meta-analysis, Pre-eclampsia, Risk predictors, Screening, Systematic review
• Publisher URL: http://dx.doi.org/10.1007/s00125-016-4098-x