Verhoogd risico op diabetes mellitus type 2 en hart-en vaatziekten na diabetes gravidarum

Objective To determine the longterm risk of developing type II diabetes (T2D) and cardiovascular disease (CVD) for women with a history of gestational diabetes mellitus. Design Systematic review and metaanalysis. Method Two search strategies were used in PubMed and Embase to determine the longterm risks of developing T2D and CVD after a pregnancy complicated by gestational diabetes mellitus. After critical appraisal of the papers found, 11 papers were included, involving a total of 328,423 patients. Absolute and relative risks (RRs) were calculated. Results Eight studies (n=276,829) reported on the longterm risk of T2D and 4 (n=141,048) on the longterm risk of CVD. Followup ranged from 3.5 to 11.5 years for T2D and from 1.2 to 74.0 years for CVD. Women with gestational diabetes had a risk of T2D varying between 9.5% and 37.0% and a risk of CVD of between 0.28% and 15.5%. Women with gestational diabetes were at increased risk of T2D (weighted RR: 13.2 95% CI: 8.520.7) and CVD (weighted RR: 2.0 95% CI: 1.13.7) compared to women without gestational diabetes. Conclusion Women with prior gestational diabetes mellitus have a significantly increased risk of developing T2D and CVD. It is very important that gestational diabetes is recognised as a cardiovascular risk factor in daily practice. It would be desirable to screen this group of women for the presence of hyperglycaemia and other cardiovascular risk factors. Further research is required to be able to specify the longterm risk of T2D and CVD and to demonstrate whether such screening is costeffective. Conflict of interest: none declared. Financial support: none declared