Long-term follow-up on morbidity among women with a history of gestational diabetes mellitus: a systematic review
Background. Gestational diabetes mellitus (GDM) complicates up to 10% of pregnancies and is a well-known risk factor of type 2 diabetes mellitus (T2DM) and cardiovascular disease later in life, but little is known about the possible long-term risks of other diseases. The aim of this study was to review the literature for evidence of associations with morbidity other than T2DM and cardiovascular disease and with long-term mortality. Methods. A systematic review based on searches in Medline, Embase and the Cochrane Library until 31st March 2021, using a broad range of keywords. We extracted study characteristics and results on associations between GDM and disease occurrence at least 10 years postpartum, excluding studies on women with DM prior to pregnancy or only DM prior to outcome The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Results. We screened 3,084 titles, 81 articles were assessed full-text, and 15 were included in the review. The strongest evidence for an association was found for kidney diseases, particularly in black women. We found indication of an association with liver disease, but possibly restricted to women who had developed DM postpartum. The association between GDM and breast cancer had been studied extensively, but in most cases based on self-reported diagnosis and with conflicting results. Only sparse and inconsistent results were found for other cancers. No study on thyroid diseases was found, and no study reported on short-term or long-term mortality in women with a history of GDM. Conclusion. Given the frequency of GDM, there is a need for better evidence on possible long-term health consequences. In particular, studies based on comprehensive records of diagnosis of both GDM, and long-term health outcomes are warranted.