title: Pre-eclampsia is associated with a twofold increase in diabetes: a systematic review and meta-analysis.
abstract: Pre-eclampsia is a pregnancy-specific multisystem disorder and a state of physiological insulin resistance. Our aim was to systematically evaluate and quantify the evidence on the relationship between pre-eclampsia and the future risk of diabetes.
  
  
  
  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.
  
  
  
  A total of 21 studies were identified with more than 2.8 million women, including more than 72,500 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 (RR 2.37 [95% CI 1.89, 2.97]). This risk appeared in studies that followed women from less than 1 year postpartum (RR 1.97 [95% CI 1.35, 2.87]) and persisted to more than 10 years postpartum (RR 1.95 [95% CI 1.28, 2.97]). After adjusting for BMI or gestational diabetes, pre-eclampsia remained linked with an increased risk of future diabetes (RR 2.38 [95% CI 1.74, 3.24] and RR 2.36 [95% CI 1.94, 2.88], respectively).
  
  
  
  Pre-eclampsia is independently associated with a twofold 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.
authors.affiliation: Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, UK. p.wu@keele.ac.uk.|Academic Obstetrics and Gynaecology, Maternity Centre, Royal Stoke University Hospital, Stoke-on-Trent, UK. p.wu@keele.ac.uk.
authors.forename: Pensee
authors.initials: P
authors.lastname: Wu
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|The Heart Centre, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.
authors.forename: Randula
authors.initials: R
authors.lastname: Haththotuwa
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
authors.forename: Rafail A
authors.initials: RA
authors.lastname: Kotronias
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
authors.forename: Aswin
authors.initials: A
authors.lastname: Babu
authors.affiliation: Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, UK.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Fryer
authors.affiliation: Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.|NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands, Keele University, Stoke-on-Trent, UK.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|The Heart Centre, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000503:physiopathology*; D011247:Pregnancy; D012307:Risk Factors
keywords: Diabetes mellitus; Meta-analysis; Pre-eclampsia; Risk predictors; Screening; Systematic review