Long-term risk of all-cause mortality and cardiovascular events in women with gestational diabetes mellitus: a systematic review and meta-analysis

Background: This meta-analysis investigates the long-term association between gestational diabetes mellitus (GDM) and the risks of all-cause mortality and specific cardiovascular events in women. Methods: We analyzed 9 high-quality cohort studies involving 4,191,840 women (age range: 24.5-34.6 years). Results: Compared to women without GDM, those with a history of GDM had significantly increased risks of: All-cause mortality (HR = 1.29, 95% CI 1.09-1.52),Acute heart failure (HR = 1.74, 95% CI 1.36-2.23), Myocardial infarction (HR = 1.63, 95% CI 1.38-1.91), Ischemic stroke (HR = 1.70, 95% CI 1.28-2.26). Heterogeneity was observed for all outcomes except myocardial infarction. Sensitivity analyses confirmed the robustness of the findings. The absolute incidence of all-cause mortality was also higher in the GDM group (3.2% vs. 2.5%). No significant publication bias was detected. Conclusion: GDM is significantly associated with elevated long-term risks of all-cause mortality and cardiovascular morbidity. These findings underscore the necessity for long-term monitoring and preventive strategies in this population, even after postpartum glucose normalization. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025649099.