Clustering in gestational diabetes mellitus: A systematic review

BACKGROUND: Gestational diabetes mellitus (GDM) is a heterogenous disease with significant clinical variation. Studies of GDM clusters that are distinctive in terms of maternal characteristics could pave the way for more personalized treatments. AIM: We aimed to collate studies dealing with clusters of GDM published in the literature. METHODS: A search strategy was developed and databases such as PubMed, EMBASE, Scopus, and Ovid were searched until August 2024. Two reviewers (with a third if there was disagreement) screened the title/abstract and full text of articles and identified studies that performed clustering analysis or reported different clusters of GDM. The findings from the included studies were summarized. RESULTS: From the comprehensive literature search, 1579 studies were identified. After removal of duplicate studies, 990 studies were screened based on title/abstract, from which 24 full-text studies were selected, with 14 studies finally included in this systematic review. From these studies, it can be seen that clustering was performed mainly based on values of oral glucose tolerance tests. Other means of clustering in the literature also included metabolic, insulin, genetic and continuous glucose monitoring parameters. CONCLUSION: There are several studies reporting on clustering of GDM. However, future studies should identify the most appropriate way to stratify women diagnosed with GDM in order to improve pregnancy outcomes and beyond.