Metabolic trajectory from gestational to type 2 diabetes mellitus: a systematic review and meta-analysis

This systematic review and meta-analysis of 15 contemporary cohort studies (2020-2026) evaluates the progression from gestational diabetes mellitus (GDM) to type 2 diabetes (T2DM). Screening 1,809 records, the study identified a significant pooled T2DM incidence of 9.0% (ES: 0.09; 95% CI, 0.04-0.13), with an adjusted estimate of 6.9% after addressing publication bias. Statistical consistency was high across all strata (I² = 0%), indicating a universal metabolic phenomenon. Key clinical determinants significantly increasing T2DM risk included abnormal gestational OGTT results (ES: 4.28), maternal BMI > 25 kg/m² (ES: 2.58), insulin requirement during pregnancy (ES: 2.21), and positive family history (ES: 2.00). The findings underscore that GDM serves as a critical window for future health. Healthcare systems must move beyond generalized advice to prioritize high-risk phenotypes, particularly women with obesity or severe gestational hyperglycemia. Integrating structured, risk-stratified postpartum surveillance and lifestyle interventions within the first year after delivery is essential to mitigate the long-term global burden of T2DM. This evidence advocates for standardized, globally consistent screening protocols to bridge the current gap in postpartum compliance and improve maternal metabolic outcomes.