<p>Long-term maternal foetal outcomes for HIP.</p>

Objective
The global prevalence of type 2 diabetes mellitus has significantly risen in recent decades, leading to a corresponding increase in the incidence of diabetes-complicated pregnancies. Hyperglycaemia in pregnancy (HIP), the most common metabolic complication encountered during pregnancy, is associated with a range of adverse maternal and foetal outcomes. This systematic review comprehensively examined the maternal, foetal, neonatal, childhood, and long-term maternal outcomes of HIP in Africa.
Methods
A systematic review of all studies investigating HIP outcomes in Africa from January 1998 to February 2025 was undertaken. We searched PubMed-MEDLINE, Cochrane Library, Scopus, CINAHL (EBSCOhost), Embase and Web of Science databases for eligible studies. Studies were included if they were observational studies describing outcomes of HIP in Africa. For each outcome, study results were synthesised using an inverse variance heterogeneity meta-analysis with the Freeman-Tukey transformation. Heterogeneity was assessed using the I2 statistic, and publication bias was assessed using Doi plots.
Results
Thirty studies were included in the review, comprising 9742 participants. These studies were conducted across the following African countries: South Africa (n = 11), Ethiopia (n = 4), Nigeria (n = 3), Sudan (n = 3), Uganda (n = 2), and one each from Ghana, Algeria, Morocco, Democratic Republic of Congo, Zimbabwe, Togo, and Egypt. The most common adverse pregnancy outcomes for gestational diabetes mellitus (GDM) were caesarean section (CS) (overall prevalence 46.0%, 95% CI 35.7–56.4, I2 = 95.6%), preterm delivery (overall prevalence 25.2% (95% CI 12.7–40.2, I2 = 96.7%) and neonatal intensive care unit (NICU) admission (overall prevalence 25.9% (95% CI 13.7–40.2, I2 = 85.7%). The most common adverse pregnancy outcomes for women with preexisting type 1 diabetes (T1DM) were CS (overall prevalence 57.5%, 95% CI 44.9–69.7, I2 = 81.2%), preterm delivery (overall prevalence 50.7%, 95% CI 16.3–84.8, I2 = 92.6%), and neonatal hypoglycaemia (overall prevalence 20.2%, 95% CI 0.0–61.4, I2 = 94.6%). CS (overall prevalence 60.6%, 95% CI 45.5–74.8, I2 = 93.6%) and preterm delivery (overall prevalence 35.2%, 95% CI 29.5–41.1, I2 = 49.3%) were the most prevalent adverse pregnancy outcomes for women with preexisting type 2 diabetes (T2DM). Postpartum T2DM was the most common long-term adverse outcome of women who had GDM or hyperglycaemia first detected in pregnancy (HFDP). There was significant heterogeneity across most outcomes.
Conclusions
The prevalence of adverse outcomes of HIP in Africa is high, in particular CS, preterm delivery and neonatal hypoglycaemia, with higher frequencies in pregestational T1DM and T2DM compared to GDM. Additionally, T2DM prevalence in women post-GDM is about 50%. The outcome data predominantly come from a few studies, indicating the necessity for more high-quality research to improve HIP-related maternal and child health in Africa. The high heterogeneity across most outcomes suggests that their prevalence varies across populations and underscores the need for more high-quality data. PROSPERO Registration Number: CRD42020184573.

研究目的
近数十年来，全球2型糖尿病（type 2 diabetes mellitus）患病率显著上升，糖尿病合并妊娠的发病率亦随之同步升高。妊娠期高血糖（Hyperglycaemia in pregnancy, HIP）是妊娠期最常见的代谢并发症，与多种不良母胎结局密切相关。本系统综述全面评估了非洲地区妊娠期高血糖的母体、胎儿、新生儿、儿童期及远期母体结局。

研究方法
本研究针对1998年1月至2025年2月期间所有探讨非洲地区妊娠期高血糖结局的研究开展系统综述。我们检索了PubMed-MEDLINE、考克兰图书馆（Cochrane Library）、Scopus、CINAHL（EBSCOhost平台）、Embase及Web of Science数据库，以筛选符合纳入标准的研究。纳入标准为：针对非洲地区妊娠期高血糖结局的观察性研究。针对每项结局指标，采用逆方差异质性Meta分析（inverse variance heterogeneity meta-analysis）结合Freeman-Tukey变换对研究结果进行合并分析。采用I²统计量评估异质性，采用Doi图评估发表偏倚。

研究结果
本综述共纳入30项研究，涉及9742名研究对象。这些研究覆盖以下非洲国家：南非（n=11）、埃塞俄比亚（n=4）、尼日利亚（n=3）、苏丹（n=3）、乌干达（n=2），以及加纳、阿尔及利亚、摩洛哥、刚果（金）、津巴布韦、多哥和埃及各1项。
针对妊娠期糖尿病（gestational diabetes mellitus, GDM）患者，最常见的不良妊娠结局为剖宫产（caesarean section, CS）（总体患病率46.0%，95%CI 35.7~56.4，I²=95.6%）、早产（总体患病率25.2%，95%CI 12.7~40.2，I²=96.7%）及新生儿重症监护病房（neonatal intensive care unit, NICU）收治率（总体患病率25.9%，95%CI 13.7~40.2，I²=85.7%）。
针对孕前1型糖尿病（preexisting type 1 diabetes, T1DM）患者，最常见的不良妊娠结局为剖宫产（总体患病率57.5%，95%CI 44.9~69.7，I²=81.2%）、早产（总体患病率50.7%，95%CI 16.3~84.8，I²=92.6%）及新生儿低血糖（总体患病率20.2%，95%CI 0.0~61.4，I²=94.6%）。
针对孕前2型糖尿病（preexisting type 2 diabetes, T2DM）患者，最常见的不良妊娠结局为剖宫产（总体患病率60.6%，95%CI 45.5~74.8，I²=93.6%）及早产（总体患病率35.2%，95%CI 29.5~41.1，I²=49.3%）。
产后2型糖尿病是妊娠期首次发现高血糖（hyperglycaemia first detected in pregnancy, HFDP）或妊娠期糖尿病患者最常见的远期不良结局。多数结局指标均存在显著异质性。

研究结论
非洲地区妊娠期高血糖相关不良结局的患病率较高，尤其是剖宫产、早产及新生儿低血糖，且孕前1型糖尿病和孕前2型糖尿病患者的不良结局发生率高于妊娠期糖尿病患者。此外，妊娠期糖尿病患者产后2型糖尿病患病率约为50%。现有结局数据主要来自少数研究，提示亟需开展更多高质量研究，以改善非洲地区妊娠期高血糖相关的母胎健康。多数结局指标存在显著异质性，表明不同人群的结局患病率存在差异，进一步凸显了获取更多高质量数据的必要性。本研究PROSPERO注册号：CRD42020184573。