Arantxa González-Saitz, Susanne Kaser
Our data show a high prevalence of islet autoantibody positivity in patients with gestational diabetes suggesting a relevant pathophysiological role of autoimmunity in a subgroup of affected patients. These data underline the need of postpartum analysis of the autoantibody status and regular follow-up checks in patients with persistent islet autoantibody positivity. Heterogeneity among analyzed studies was high underlining the need of further prospective studies to more clearly define the role of islet autoantibodies in patients with gestational diabetes.
INTRODUCTION: Gestational diabetes (GDM) is not only associated with markedly increased type 2 diabetes risk but is also associated with increased type 1 diabetes risk in later life. The aim of this work was to systematically evaluate the prevalence and clinical relevance of islet autoantibodies in patients with gestational diabetes.
METHOD: A systematic literature search of the predefined keywords "gestational diabetes" or "pregnancy diabetes" and "autoantibodies" in the electronic databases PubMed, ScienceDirect, and ResearchGate from the beginning of the database until November 30, 2025 was performed. The selection of publications was based on the review of studies using predefined inclusion and exclusion criteria. The extracted data obtained were analyzed using meta-analytical techniques.
RESULTS: Twenty-one studies including a total of 7760 patients with gestational diabetes were included. Heterogeneity among the analyzed studies was high. The overall prevalence of islet autoantibodies was 10.6% (95% CI 8,2-13,0%) (I2 = 95,9%) in patients with gestational diabetes, which was more than seven-fold higher than in pregnant women without gestational diabetes. Prevalence was highest for ICA and anti-GAD autoantibodies. The prevalence of islet autoantibodies decreased from 10.6% during pregnancy to 3.6% in the postpartum period (95% CI 2.1-5.1%).
CONCLUSION: Our data show a high prevalence of islet autoantibody positivity in patients with gestational diabetes suggesting a relevant pathophysiological role of autoimmunity in a subgroup of affected patients. These data underline the need of postpartum analysis of the autoantibody status and regular follow-up checks in patients with persistent islet autoantibody positivity. Heterogeneity among analyzed studies was high underlining the need of further prospective studies to more clearly define the role of islet autoantibodies in patients with gestational diabetes.