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The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis

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Abstract

Aims

The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA) intima-media thickness (IMT) is still controversial. This systematic review and meta-analysis was performed to assess the correlation between GDM and CCA-IMT in and after pregnancy.

Methods

PubMed and EMBASE databases were systematically reviewed on April 2023. Studies measuring CCA-IMT in both pregnant women with GDM and women with previous history of GDM (pGDM) vs. healthy controls were included. The subtotal and overall standardized mean differences (SMDs) of CCA-IMT were calculated using the random-effect model.

Results

Nineteen studies with a total of 302 GDM and 861 pGDM women were analyzed. The average value of CCA-IMT measured in GDM/pGDM (0.59 ± 0.12 mm) was slightly increased in comparison to the accepted reference limits of IMT according to age classes. Substantial heterogeneity was detected for the studies involving both GDM and pGDM women, with an overall statistic I2 of 86.0% (p < 0.001). Large SMDs were obtained for the studies conducted on both GDM and pGDM women, with an overall SMD of 0.89 (95%CI 0.63–1.15, p < 0.001). Egger's test for a regression intercept gave a p-value of 0.37, indicating no publication bias. On meta-regression analysis, all potential confounders (number of patients, age at pregnancy, body mass index, measuring time, follow-up duration and GDM criteria) were not significantly associated with effect modification.

Conclusions

GDM in and after pregnancy is independently associated with subclinical atherosclerosis. The association between GDM and carotid remodeling is potentially mediated by the longstanding underlying risk.

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Data availability

Data extracted from included studies are publicly available on Zenodo (https://zenodo.org).

Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

ADA:

American Diabetes Association

BMI:

Body mass index

CCA:

Common carotid artery

DBP:

Diastolic blood pressure

EFT:

Epicardial fat thickness

FGF-23:

Fibroblast growth factor-23

GDM:

Gestational diabetes mellitus

GTT:

Glucose tolerance test

HOMA-IR:

Homeostasis model of assessment-insulin resistance

hsCRP:

High-sensitivity C-reactive protein

IADPSG:

International Association of Diabetes and Pregnancy Study Groups

IMT:

Intima-media thickness

NIH:

National Institutes of Health

NLR:

Neutrophil-to-lymphocyte ratio

pGDM:

Previous gestational diabetes mellitus

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyzes

RoB:

Risk of bias

SMD:

Standardized mean difference

WHO:

World Health Organization

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Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Division of Cardiology, IRCCS MultiMedica, Milan, Italy

    Andrea Sonaglioni & Michele Lombardo

  2. Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy

    Elisabetta Piergallini & Stefano Bianchi

  3. Division of Urology, IRCCS MultiMedica, Milan, Italy

    Angelo Naselli

  4. Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

  5. Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy

    Anna Ferrulli

  6. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Anna Ferrulli

  7. Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria “S. Maria Della Misericordia”, Perugia, Italy

    Giuseppe Ambrosio

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  1. Andrea Sonaglioni
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Contributions

A.S. contributed to Conceptualization; A.S., E.P., G.L.N. contributed to Data curation; A.S., E.P., A.N. contributed to Formal analysis; A.S., E.P. contributed to Investigation; A.S., E.P., A.N. contributed to Methodology; A.S., E.P., G.L.N. contributed to Writing—original draft; A.S., E.P., G.L.N., G.A contributed to Writing—review & editing; Supervision, A.F., S.B., M.L., G.A. contributed to Supervision. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Andrea Sonaglioni.

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Sonaglioni, A., Piergallini, E., Naselli, A. et al. The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis. Acta Diabetol 61, 139–149 (2024). https://doi.org/10.1007/s00592-023-02206-9

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