Gestational Diabetes Mellitus and Heart Failure: A Systematic Review and Meta-Analysis

The extent of the association between gestational diabetes mellitus (GDM) and the incidence of heart failure (HF) largely remains unclear.

The aim of the study was to synthesize the evidence on the association of GDM and risk of HF.

This study is a systematic review and meta-analysis. We searched PubMed and Embase through July 24, 2024, for cohort studies reporting on the GDM and HF association. We pooled adjusted relative risk (RR) estimates of the association of GDM and HF using a random-effects model meta-analysis.

In a meta-analysis of 8 observational studies, a total of 6,371,877 participants (weighted averages-age: 28.7 years, 89.7% White, body mass index 25.6 kg/m², 310,351 with GDM) were assessed and experienced 12,409 incident HF events over ∼8.6 years (weighted average). The pooled adjusted RR for the GDM and HF association was 1.54 (95% CI: 1.24-1.92). There was heterogeneity across the studies (I² = 86.9%, P < 0.001). Sensitivity analyses, excluding the smallest and largest studies, did not appreciably change the significance and magnitude of the overall RR estimate of the risk of HF related to GDM.

The observed independent association of GDM with HF suggests a potential causal role of GDM in adverse myocardial remodeling. A history of GDM should be considered as a risk factor in the efforts to prevent HF.