Evidence:

• The 10-year incidence of type 2 diabetes is 20% to 50% following a pregnancy complicated by gestational diabetes (8).
• A systematic review of 28 studies examining the risk of type 2 diabetes among women with gestational diabetes found a cumulative incidence of diabetes of 2.6% to 70% from 6 weeks to 28 years postpartum. The highest incidence occurred in the first 5 years after the index pregnancy, and the risk appeared to plateau after 10 years (12).
• Rates of diabetes progression appear to be higher among Latin and Native American women with gestational diabetes, but follow-up lengths and retention rates vary widely between studies. Because no direct comparisons between populations have been made, it is uncertain whether risk of future diabetes is truly different based on ethnicity (12).
• A study found that in women with gestational diabetes followed prospectively for up to 11 years, those with autoantibodies to glutamic acid decarboxylase and/or insulinoma antigen-2, those who required insulin during gestation, those with BMI 30 kg/m², and those with a history of two or more prior pregnancies had hazard ratios of between 1.5 and 4.7 for development of type 2 diabetes. The highest risk at 8 years occurred in antibody-positive women (96%). In the group with none of the above attributes, the prospective incidence was 14% (13).
• According to a systematic review for the USPSTF on screening for gestational diabetes mellitus, there is limited evidence that gestational diabetes treatment after 24 weeks improves some maternal and neonatal outcomes. Evidence is even more sparse for screening before 24 weeks' gestation (14).

Comments:

• None.