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

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

doi:10.1007/s00125-016-4098-x

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

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

Research output: Contribution to journal › Article › peer-review

64 Citations (Scopus)

12 Downloads (Pure)

Abstract

Aims/hypothesis

Pre-eclampsia is a pregnancy-specific multisystem disorder and a state of physiological insulin resistance. Our aim was 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

A total of 21 studies were identified with more than 2.8 million women, including more than 72,500 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 (RR 2.37 [95% CI 1.89, 2.97]). This risk appeared in studies that followed women from less than 1 year postpartum (RR 1.97 [95% CI 1.35, 2.87]) and persisted to more than 10 years postpartum (RR 1.95 [95% CI 1.28, 2.97]). After adjusting for BMI or gestational diabetes, pre-eclampsia remained linked with an increased risk of future diabetes (RR 2.38 [95% CI 1.74, 3.24] and RR 2.36 [95% CI 1.94, 2.88], respectively).

Conclusions/interpretation

Pre-eclampsia is independently associated with a twofold 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.

Original language	English
Pages (from-to)	2518-2526
Number of pages	9
Journal	Diabetologia
Volume	59
Issue number	12
Early online date	19 Sept 2016
DOIs	https://doi.org/10.1007/s00125-016-4098-x
Publication status	Published - Dec 2016

Bibliographical note

CSK and RH are funded by National Institute for Health Research Academic Clinical Fellowships. This study was supported by a grant from the North Staffs Heart Committee.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

diabetes mellitus
meta-analysis
pre-eclampsia
risk predictors
screening
systematic review

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Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis
© The Author(s) 2016 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Final published version, 580 KBLicence: CC BY

Cite this

@article{75bbda44e67f4e63a52bf4da2acca260,

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

abstract = "Aims/hypothesis Pre-eclampsia is a pregnancy-specific multisystem disorder and a state of physiological insulin resistance. Our aim was 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 A total of 21 studies were identified with more than 2.8 million women, including more than 72,500 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 (RR 2.37 [95\% CI 1.89, 2.97]). This risk appeared in studies that followed women from less than 1 year postpartum (RR 1.97 [95\% CI 1.35, 2.87]) and persisted to more than 10 years postpartum (RR 1.95 [95\% CI 1.28, 2.97]). After adjusting for BMI or gestational diabetes, pre-eclampsia remained linked with an increased risk of future diabetes (RR 2.38 [95\% CI 1.74, 3.24] and RR 2.36 [95\% CI 1.94, 2.88], respectively). Conclusions/interpretation Pre-eclampsia is independently associated with a twofold 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.",

keywords = "diabetes mellitus, meta-analysis, pre-eclampsia, risk predictors, screening, systematic review",

author = "Pensee Wu and Kwok, \{Chun Shing\} and Randula Haththotuwa and Kotronias, \{Rafail A\} and Aswin Babu and Fryer, \{Anthony A.\} and Myint, \{Phyo K.\} and Chew-Graham, \{Carolyn A\} and Mamas, \{Mamas A\}",

note = "CSK and RH are funded by National Institute for Health Research Academic Clinical Fellowships. This study was supported by a grant from the North Staffs Heart Committee.",

year = "2016",

month = dec,

doi = "10.1007/s00125-016-4098-x",

language = "English",

volume = "59",

pages = "2518--2526",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "12",

}

TY - JOUR

T1 - Pre-eclampsia is associated with a twofold increase in diabetes

T2 - a systematic review and meta-analysis

AU - Wu, Pensee

AU - Kwok, Chun Shing

AU - Haththotuwa, Randula

AU - Kotronias, Rafail A

AU - Babu, Aswin

AU - Fryer, Anthony A.

AU - Myint, Phyo K.

AU - Chew-Graham, Carolyn A

AU - Mamas, Mamas A

N1 - CSK and RH are funded by National Institute for Health Research Academic Clinical Fellowships. This study was supported by a grant from the North Staffs Heart Committee.

PY - 2016/12

Y1 - 2016/12

N2 - Aims/hypothesis Pre-eclampsia is a pregnancy-specific multisystem disorder and a state of physiological insulin resistance. Our aim was 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 A total of 21 studies were identified with more than 2.8 million women, including more than 72,500 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 (RR 2.37 [95% CI 1.89, 2.97]). This risk appeared in studies that followed women from less than 1 year postpartum (RR 1.97 [95% CI 1.35, 2.87]) and persisted to more than 10 years postpartum (RR 1.95 [95% CI 1.28, 2.97]). After adjusting for BMI or gestational diabetes, pre-eclampsia remained linked with an increased risk of future diabetes (RR 2.38 [95% CI 1.74, 3.24] and RR 2.36 [95% CI 1.94, 2.88], respectively). Conclusions/interpretation Pre-eclampsia is independently associated with a twofold 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.

AB - Aims/hypothesis Pre-eclampsia is a pregnancy-specific multisystem disorder and a state of physiological insulin resistance. Our aim was 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 A total of 21 studies were identified with more than 2.8 million women, including more than 72,500 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 (RR 2.37 [95% CI 1.89, 2.97]). This risk appeared in studies that followed women from less than 1 year postpartum (RR 1.97 [95% CI 1.35, 2.87]) and persisted to more than 10 years postpartum (RR 1.95 [95% CI 1.28, 2.97]). After adjusting for BMI or gestational diabetes, pre-eclampsia remained linked with an increased risk of future diabetes (RR 2.38 [95% CI 1.74, 3.24] and RR 2.36 [95% CI 1.94, 2.88], respectively). Conclusions/interpretation Pre-eclampsia is independently associated with a twofold 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.

KW - diabetes mellitus

KW - meta-analysis

KW - pre-eclampsia

KW - risk predictors

KW - screening

KW - systematic review

U2 - 10.1007/s00125-016-4098-x

DO - 10.1007/s00125-016-4098-x

M3 - Article

SN - 0012-186X

VL - 59

SP - 2518

EP - 2526

JO - Diabetologia

JF - Diabetologia

IS - 12

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

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