Evidence of the Month

1. Evidence of the Month Comment on: Recurrence of gestational diabetes mellitus: a systematic review

2. Goals: Examine rates and factors associated with recurrence of gestational diabetes among women with a history of gestational diabetes Design: Meta-analysis of literature published between January 1965 and November 2006 Methods: Abstracted factors included recurrence rates, time between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, BMI or weight gain at initial and later pregnancy, insulin use, gestational age at diagnosis, glucose, levels, baby birth weight Outcome: Rates and risk factors for gestational diabetes Methods/primary outcome

3. Recurrence of gestational diabetes Lower rates of recurrence were found in studies of white populations, and higher rates were found in studies of African American, Latina, and Asian populations No other factor (other than race/ethnicity) was consistently reported to predict actual recurrence of gestational diabetes The most surprising result was that recurrence was far from 100%, suggesting that diabetes in pregnancy may be different from other types of diabetes at least in some cases

4. Conclusions Most consistent predictor of future recurrence was race/ethnicity (although racial breakdowns within a study were not explicit) African American, Latina, and Asian populations had markedly higher recurrence, even after pre-existing diabetes before subsequent pregnancy was taken into account Other factors, such as maternal age, parity, BMI, oral glucose tolerance test levels, and insulin use, inconsistently predicted development of recurrent gestational diabetes across studies A significant portion of subsequent gestational diabetes pregnancies may be affected by pre-existing diabetes Thus, increased screening for diabetes pre-pregnancy may lower the rate of gestational diabetes pregnancies, particularly in women with previous gestational diabetes