{"title":"显性糖尿病女性与正常血糖、妊娠期糖尿病和既往糖尿病女性的妊娠和产后心脏代谢结局：一项系统回顾和荟萃分析","authors":"Adarsh Pal, Dimple Rawat, Sankeerth Sadananda, Alpesh Goyal, Partha Haldar, Deepali Garg, Yashdeep Gupta, Nikhil Tandon","doi":"10.1111/dom.16400","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>Overt diabetes in pregnancy (ODiP) is a condition identified by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) in 2010. Despite the clinical significance, our knowledge regarding its impact during pregnancy and the postpartum period is limited due to small sample sizes in previous studies. This systematic review and meta-analysis (SRM) aimed to consolidate evidence on outcomes in the pregnancy and postpartum period among women with ODiP in comparison to women with gestational diabetes mellitus (GDM), pre-existing diabetes (PED) and normoglycaemia.</p><p><strong>Material and methods: </strong>A comprehensive search was conducted across PubMed, Embase and Scopus for relevant studies published from January 1, 2010, to May 31, 2024. Eleven studies, including data from 16 135 pregnancies, were analysed.</p><p><strong>Results: </strong>Women with ODiP had a significantly higher risk of gestational hypertension (RR 1.93; 95% CI 1.45, 2.58), pre-eclampsia (RR 1.65; 95% CI 1.26, 2.16) and caesarean delivery (RR 1.14; 95% CI 1.01, 1.29) compared with GDM. Adverse neonatal outcomes such as large for gestational age (RR 1.45; 95% CI 1.13, 1.85), macrosomia (RR 1.66; 95% CI 1.05, 2.64), neonatal hypoglycaemia (RR 1.52; 95% CI 1.06, 2.19) and stillbirth (RR 4.30; 95% CI 1.69, 10.98) were also significantly higher than GDM. The risk of postpartum diabetes was 6 times higher than in women with GDM and 25 times higher than in women with normoglycaemia. Variations in diagnostic criteria and postpartum follow-up duration contributed to heterogeneity.</p><p><strong>Conclusion: </strong>This SRM demonstrates that ODiP is associated with significantly worse pregnancy and postpartum outcomes compared with GDM and normoglycaemia in pregnancy. These findings underscore the need for targeted clinical strategies to manage ODiP and mitigate adverse maternal and neonatal outcomes.</p>","PeriodicalId":158,"journal":{"name":"Diabetes, Obesity & Metabolism","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pregnancy and postpartum cardiometabolic outcomes among women with overt diabetes compared to women with normoglycaemia, gestational diabetes and pre-existing diabetes: A systematic review and meta-analysis.\",\"authors\":\"Adarsh Pal, Dimple Rawat, Sankeerth Sadananda, Alpesh Goyal, Partha Haldar, Deepali Garg, Yashdeep Gupta, Nikhil Tandon\",\"doi\":\"10.1111/dom.16400\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aim: </strong>Overt diabetes in pregnancy (ODiP) is a condition identified by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) in 2010. Despite the clinical significance, our knowledge regarding its impact during pregnancy and the postpartum period is limited due to small sample sizes in previous studies. This systematic review and meta-analysis (SRM) aimed to consolidate evidence on outcomes in the pregnancy and postpartum period among women with ODiP in comparison to women with gestational diabetes mellitus (GDM), pre-existing diabetes (PED) and normoglycaemia.</p><p><strong>Material and methods: </strong>A comprehensive search was conducted across PubMed, Embase and Scopus for relevant studies published from January 1, 2010, to May 31, 2024. Eleven studies, including data from 16 135 pregnancies, were analysed.</p><p><strong>Results: </strong>Women with ODiP had a significantly higher risk of gestational hypertension (RR 1.93; 95% CI 1.45, 2.58), pre-eclampsia (RR 1.65; 95% CI 1.26, 2.16) and caesarean delivery (RR 1.14; 95% CI 1.01, 1.29) compared with GDM. Adverse neonatal outcomes such as large for gestational age (RR 1.45; 95% CI 1.13, 1.85), macrosomia (RR 1.66; 95% CI 1.05, 2.64), neonatal hypoglycaemia (RR 1.52; 95% CI 1.06, 2.19) and stillbirth (RR 4.30; 95% CI 1.69, 10.98) were also significantly higher than GDM. The risk of postpartum diabetes was 6 times higher than in women with GDM and 25 times higher than in women with normoglycaemia. Variations in diagnostic criteria and postpartum follow-up duration contributed to heterogeneity.</p><p><strong>Conclusion: </strong>This SRM demonstrates that ODiP is associated with significantly worse pregnancy and postpartum outcomes compared with GDM and normoglycaemia in pregnancy. These findings underscore the need for targeted clinical strategies to manage ODiP and mitigate adverse maternal and neonatal outcomes.</p>\",\"PeriodicalId\":158,\"journal\":{\"name\":\"Diabetes, Obesity & Metabolism\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2025-04-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetes, Obesity & Metabolism\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/dom.16400\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes, Obesity & Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/dom.16400","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：妊娠期显性糖尿病（ODiP）是2010年国际糖尿病和妊娠研究小组协会（IADPSG）确定的一种疾病。尽管具有临床意义，但由于以前的研究样本量小，我们对其在妊娠和产后期间的影响的了解有限。本系统综述和荟萃分析（SRM）旨在巩固ODiP妇女与妊娠期糖尿病（GDM）、既往糖尿病（PED）和血糖正常者相比妊娠和产后结局的证据。材料和方法：综合检索PubMed、Embase和Scopus，检索2010年1月1日至2024年5月31日发表的相关研究。研究人员分析了11项研究，包括16135例怀孕的数据。结果：ODiP患者发生妊娠期高血压的风险显著增高(RR 1.93；95% CI 1.45, 2.58)，先兆子痫(RR 1.65；95% CI 1.26, 2.16)和剖宫产(RR 1.14；95% CI 1.01, 1.29)。不良新生儿结局，如胎龄大(RR 1.45；95% CI 1.13, 1.85)，巨大儿(RR 1.66；95% CI 1.05, 2.64)，新生儿低血糖(RR 1.52；95% CI 1.06, 2.19)和死胎(RR 4.30；95% CI 1.69, 10.98)也显著高于GDM。产后糖尿病的风险比GDM妇女高6倍，比血糖正常妇女高25倍。诊断标准和产后随访时间的差异导致了异质性。结论：该SRM表明，与妊娠期GDM和妊娠期血糖正常者相比，ODiP与妊娠期和产后预后明显较差相关。这些发现强调需要有针对性的临床策略来管理ODiP和减轻孕产妇和新生儿的不良结局。
Pregnancy and postpartum cardiometabolic outcomes among women with overt diabetes compared to women with normoglycaemia, gestational diabetes and pre-existing diabetes: A systematic review and meta-analysis.
Background and aim: Overt diabetes in pregnancy (ODiP) is a condition identified by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) in 2010. Despite the clinical significance, our knowledge regarding its impact during pregnancy and the postpartum period is limited due to small sample sizes in previous studies. This systematic review and meta-analysis (SRM) aimed to consolidate evidence on outcomes in the pregnancy and postpartum period among women with ODiP in comparison to women with gestational diabetes mellitus (GDM), pre-existing diabetes (PED) and normoglycaemia.
Material and methods: A comprehensive search was conducted across PubMed, Embase and Scopus for relevant studies published from January 1, 2010, to May 31, 2024. Eleven studies, including data from 16 135 pregnancies, were analysed.
Results: Women with ODiP had a significantly higher risk of gestational hypertension (RR 1.93; 95% CI 1.45, 2.58), pre-eclampsia (RR 1.65; 95% CI 1.26, 2.16) and caesarean delivery (RR 1.14; 95% CI 1.01, 1.29) compared with GDM. Adverse neonatal outcomes such as large for gestational age (RR 1.45; 95% CI 1.13, 1.85), macrosomia (RR 1.66; 95% CI 1.05, 2.64), neonatal hypoglycaemia (RR 1.52; 95% CI 1.06, 2.19) and stillbirth (RR 4.30; 95% CI 1.69, 10.98) were also significantly higher than GDM. The risk of postpartum diabetes was 6 times higher than in women with GDM and 25 times higher than in women with normoglycaemia. Variations in diagnostic criteria and postpartum follow-up duration contributed to heterogeneity.
Conclusion: This SRM demonstrates that ODiP is associated with significantly worse pregnancy and postpartum outcomes compared with GDM and normoglycaemia in pregnancy. These findings underscore the need for targeted clinical strategies to manage ODiP and mitigate adverse maternal and neonatal outcomes.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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