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

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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 languageEnglish
Pages (from-to)2518-2526
Number of pages9
JournalDiabetologia
Volume59
Issue number12
Early online date19 Sep 2016
DOIs
Publication statusPublished - Dec 2016

Fingerprint

Pre-Eclampsia
Meta-Analysis
Eclampsia
Postpartum Period
Gestational Diabetes
MEDLINE
Insulin Resistance
Pregnancy
Population

Keywords

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

Cite this

Wu, P., Kwok, C. S., Haththotuwa, R., Kotronias, R. A., Babu, A., Fryer, A. A., ... Mamas, M. A. (2016). Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis. Diabetologia, 59(12), 2518-2526. https://doi.org/10.1007/s00125-016-4098-x

Pre-eclampsia is associated with a twofold increase in diabetes : a systematic review and meta-analysis. / Wu, Pensee; Kwok, Chun Shing; Haththotuwa, Randula; Kotronias, Rafail A; Babu, Aswin; Fryer, Anthony A.; Myint, Phyo K.; Chew-Graham, Carolyn A; Mamas, Mamas A.

In: Diabetologia, Vol. 59, No. 12, 12.2016, p. 2518-2526.

Research output: Contribution to journalArticle

Wu, P, Kwok, CS, Haththotuwa, R, Kotronias, RA, Babu, A, Fryer, AA, Myint, PK, Chew-Graham, CA & Mamas, MA 2016, 'Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis', Diabetologia, vol. 59, no. 12, pp. 2518-2526. https://doi.org/10.1007/s00125-016-4098-x
Wu, Pensee ; Kwok, Chun Shing ; Haththotuwa, Randula ; Kotronias, Rafail A ; Babu, Aswin ; Fryer, Anthony A. ; Myint, Phyo K. ; Chew-Graham, Carolyn A ; Mamas, Mamas A. / Pre-eclampsia is associated with a twofold increase in diabetes : a systematic review and meta-analysis. In: Diabetologia. 2016 ; Vol. 59, No. 12. pp. 2518-2526.
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abstract = "Aims/hypothesisPre-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.MethodsWe 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.ResultsA 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/interpretationPre-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.",
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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}",
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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/hypothesisPre-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.MethodsWe 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.ResultsA 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/interpretationPre-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/hypothesisPre-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.MethodsWe 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.ResultsA 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/interpretationPre-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

VL - 59

SP - 2518

EP - 2526

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 12

ER -