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Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis

Published online by Cambridge University Press:  06 January 2020

Maleesa M. Pathirana ,
Zohra S. Lassi ,
Claire T. Roberts  and
Prabha H. Andraweera Open the ORCID record for Prabha H. Andraweera [Opens in a new window]
Maleesa M. Pathirana
Affiliation:
Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
Zohra S. Lassi
Affiliation:
Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
Claire T. Roberts
Affiliation:
Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
Prabha H. Andraweera*
Affiliation:
Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
*
Address for correspondence: Prabha Andraweera, Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia. Email: [email protected]
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Abstract

Gestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle–Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57–2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02–0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08–0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.

Keywords

pregnancygestational diabetes mellituscardiovascular diseasechild health
Type
Review
Information
Journal of Developmental Origins of Health and Disease , Volume 11 , Issue 6 , December 2020 , pp. 599 - 616
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Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

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