Gestational Diabetes Mellitus and Adverse Maternal and Neonatal Health Outcomes: an Umbrella review of Meta-Analyses.

Abstract

This study systematically synthesized evidence on adverse health outcomes related to gestational diabetes mellitus (GDM) via an umbrella review with integrated meta-analyses. The search covered publications from the database (PubMed/MEDLINE, Google Scholar, Embase, and CINAHL) inception to August 12, 2024. Meta-analyses of observational studies examining the impact of GDM on maternal and neonatal health outcomes were included. Two independent researchers screened and extracted data. Associations were reanalyzed and presented as equivalent odds ratios (eORs) with 95% confidence intervals (CI). The quality of meta-analyses was assessed using AMSTAR 2, and the credibility of associations was categorized into five levels: convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or nonsignificant (NS). A total of 27 meta-analyses encompassing 85 associations were included. Among 28 significant maternal outcomes, 11 (subclinical atherosclerosis, angina, hypertension, overall cardiovascular diseases, ischemic stroke, overall stroke, combined cardiovascular/cerebrovascular diseases, subclinical left ventricle systolic dysfunction, type 2 diabetes, postpartum metabolic syndrome, and infections) were supported by convincing or highly suggestive evidence. Of 13 significant neonatal outcomes, three (atrial septal defect, congenital heart disease, and ventricular septal defect) were highly suggestive, while four of eight significant delivery outcomes (hypertensive disorders, cesarean delivery, admission to neonatal intensive care unit admission, and preterm birth) reached this level. Notably, no outcomes previously deemed nonsignificant turned significant upon reanalysis. These findings underscore the need for targeted prevention and management, and further research is needed to clarify causality and refine guidelines. PROSPERO CRD42024590322.