A meta-analysis of adverse offspring health outcomes in patients with gestational diabetes mellitus

This study aims to comprehensively evaluate the association between gestational diabetes mellitus (GDM) and the risk of chronic diseases, including obesity, glycolipid metabolic disorders, neurodevelopmental conditions and cardiovascular diseases, in offspring through a systematic meta-analysis. By searching PubMed, Web of Science and Cochrane systematic review databases, relevant observational studies published from January 2010 to February 2024 were comprehensively retrieved, and the Newcastle-Ottawa Scale was used to assess the quality of the studies. Subgroup analyses were performed based on the country status, offspring age, screening method and diagnostic criteria of GDM. A meta-regression model was used to assess the potential impact of study characteristics on the combined effect odds ratio (OR). Sensitivity analysis was conducted to examine the impact of individual studies on the overall results. Additionally, Egger's test and funnel plot analysis were utilized to assess potential publication bias. This meta-analysis included 32 studies, encompassing a total of 3 310 217 participants (90 304 women with GDM and 3 219 913 controls). Offspring exposed to GDM exhibited significantly elevated risks of obesity and overweight (OR = 1.57, 95% confidence interval [CI] [1.35, 1.82]), diabetes (OR = 4.50, 95% CI [2.87, 7.70]), autism spectrum disorder (OR = 1.38, 95% CI [1.20, 1.59]) and intellectual disabilities (OR = 1.70, 95% CI [1.52, 1.90]). Furthermore, offspring of mothers with GDM demonstrated higher systolic blood pressure (mean difference [MD] = 2.33, 95% CI [0.92, 3.75]), diastolic blood pressure (MD = 0.53, 95% CI [0.09, 0.96]), body mass index (BMI) (MD = 0.62, 95% CI [0.45, 0.80]), z-BMI score (MD = 0.27, 95% CI [0.15, 0.39]), triglyceride levels (MD = 0.04, 95% CI [0.04, 0.04]) and LDL cholesterol levels (MD = 0.02, 95% CI [0.02, 0.02]) compared to controls. In conclusion, maternal GDM is significantly associated with an increased risk of obesity, neurodevelopmental disorders, diabetes and cardiovascular diseases in offspring. Subgroup and regression analyses revealed that this association was largely unaffected by factors such as country status, offspring age, GDM screening methods or diagnostic criteria. Sensitivity analysis and bias assessment indicated that the findings were robust, with no significant publication bias detected among the included studies. GDM is a significant risk factor for offspring developing glycolipid metabolic disorders, neurodevelopmental conditions and cardiovascular diseases. This study provides a comprehensive understanding of the long-term health implications for offspring exposed to GDM, highlighting the elevated risk of chronic diseases in this population. These findings underscore the importance of implementing early preventive measures post-birth to mitigate the burden of associated chronic diseases.