A systematic review was conducted by pooling data from 8 cohort studies consisting of 6,371,877 participants. The study was published in JACC: Advances of American College of Cardiology. It was analysed to assess the relative risk of heart failure in individuals who were diagnosed with gestational diabetes mellitus (GDM). Both retrospective and prospective types were considered. The target outcome was the incidence of heart failure in these patients. 

The data were collected from PubMed and Embase for studies published till July 2024. Confounding variables such as age, body mass index [BMI], history of hypertension, etc., were adjusted. A random-effects model (statistical test) was used to calculate the relative risk (RR) of the development of heart failure in the participants. The participants were divided into two groups:- those with diagnosed GDM and those without GDM. 

Out of the total participants, 310,351 developed GBD, and 12,409 incidents of heart failure were reported. The rate of heart failure was 3.54 per 10,000 person-years for women with GDM and 1.87 per 10,000 person-years for women without GDM. The pooled RR was found to be 1.54 with a 95% C.I. for 1.24 and 1.92. Since this study had high heterogeneity (I² = 86.9%), a sensitivity analysis for the same was conducted to ensure the authenticity of the robustness of the results. 

This meta-analysis established a strong relationship between GDM and the incidence of heart failure. However, the exact reason for this association is still unclear. Possible reasons include endothelial dysfunction, myocardial remodeling, glucotoxicity, lipotoxicity, and insulin resistance.