Keele Research Repository

Aims/hypothesis: Pre-eclampsia is a pregnancy-specific multi-system disorder and a state of physiological insulin resistance. Our aim is to systematically evaluate and quantify the evidence on the relationship between pre-eclampsia and the future risk of diabetes. Methods: We conducted a systematic review and meta-analysis of studies that evaluated diabetes in women with and without pre-eclampsia. We performed a systematic search of MEDLINE and EMBASE to identify relevant studies. Independent double data extractions were conducted by four reviewers. Random effects meta-analysis was used to estimate the risk of future diabetes following pre-eclampsia. Results: Twenty-one studies were identified with over 2.8 million women including >72,000 women with pre-eclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that pre-eclampsia was independently associated with an increased risk of future diabetes (risk ratio (RR) 2.37, 95% CI 1.89, 2.97). This risk appeared in studies that followed up women from <1 year (RR 1.97, 95% CI 1.35, 2.87) and persisted to over 10 years post-partum (RR 1.95, 95% CI 1.28, 2.97). After adjusting for BMI or gestational diabetes, pre-eclampsia was linked with an increased risk of future diabetes (RR 2.38, 95% CI 1.74, 3.24) or (RR 2.36, 95% CI 1.94, 2.88), respectively. Conclusions/interpretation: Pre-eclampsia is independently associated with a two-fold increase in future diabetes. Our study highlights the importance of clinical risk assessment for the future development of diabetes in women with pre-eclampsia. We recommend detailed evaluation of a screening programme for diabetes in this high-risk population.