Gestational diabetes mellitus recurrence rate and risk factors: a systematic review and meta-analysis

Gestational diabetes mellitus (GDM) confers significant short- and long-term metabolic risks. Shifting fertility patterns have amplified concerns about GDM recurrence, but significant heterogeneity in the evidence hinders evidence-based counseling and obscures modifiable predictor identification. To address this, we conducted a systematic review and meta-analysis by searching nine electronic databases and identified 30 studies involving 30,524 women, of whom 13,610 experienced recurrence. The pooled recurrence rate was 50.7 % (95 % CI 46.6-55.2), with considerable heterogeneity (I² = 97.7 %, P < 0.001, range: 30.87-73.75 %) principally driven by diagnostic criteria differences. Ten significant risk factors were identified across maternal, obesity-related, and metabolic domains. Advanced maternal age (subsequent pregnancy ≥ 35 years: OR = 3.408, 95 % CI 2.591-4.482) and prepregnancy obesity (BMI ≥ 30 kg/m² in index pregnancy: OR = 3.248, 95 % CI 1.838-5.742; BMI ≥ 25 kg/m² in subsequent pregnancy: OR = 2.273, 95 % CI 1.463-3.530) were top predictors. Prior macrosomia (OR = 2.064, 95 % CI 1.820-2.341), index-pregnancy insulin therapy (OR = 2.353, 95 % CI 1.351-4.098) and early subsequent-pregnancy hyperglycemia (OR = 2.665, 95 % CI 2.022-3.513), hypertriglyceridemia (OR = 2.022, 95 % CI 1.548-2.641) significantly increased risk. Risk-stratified prevention must integrate initial diagnostic criteria with patient-specific factors.