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Incidence and relative risk for developing cancers in women with gestational diabetes mellitus: a nationwide cohort study in Taiwan
  1. Yun-Shing Peng1,2,
  2. Jr-Rung Lin3,
  3. Bi-Hua Cheng4,
  4. Cheng Ho1,
  5. Yung-Hsiang Lin1,
  6. Chien-Hen Shen5,
  7. Ming-Hung Tsai2,6
  1. 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
  2. 2 College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
  3. 3 Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
  4. 4 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
  5. 5 Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
  6. 6 Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
  1. Correspondence to Dr Ming-Hung Tsai; mhtsai{at}


Objectives To evaluate the risk of developing cancers, particularly site-specific cancers, in women with gestational diabetes mellitus (GDM) in Taiwan.

Setting The National Health Insurance Research Database (NHIRD) of Taiwan.

Participants This study was conducted using the nationwide data from 2000 to 2013. In total, 1 466 596 pregnant women with admission for delivery were identified. Subjects with GDM consisted of 47 373 women, while the non-exposed group consisted of 943 199 women without GDM. The participants were followed from the delivery date to the diagnosis of cancer, death, the last medical claim or the end of follow-up (31 December 2013), whichever came first.

Primary outcome measures Patients with a new diagnosis of cancer (International Classification of Diseases, ninth edition, with clinical modification (ICD-9-CM codes 140–208)) recorded in NHIRD were identified. The risk of 11 major cancer types was assessed, including cancers of head and neck, digestive organs, lung and bronchus, bone and connective tissue, skin, breast, genital organs, urinary system, brain, thyroid gland and haematological system.

Results The rates of developing cancers were significantly higher in women with GDM compared with the non-GDM group (2.24% vs 1.96%; p<0.001). After adjusting for maternal age at delivery and comorbidities, women with GDM had increased risk of cancers, including cancers of nasopharynx (adjusted HR, 1.739; 95 % CI, 1.400 to 2.161; p<0.0001), kidney (AHR, 2.169; 95 % CI, 1.428 to 3.293; p=0.0003), lung and bronchus (AHR, 1.372; 95 % CI, 1.044 to 1.803; p=0.0231), breast (AHR, 1.234; 95% CI, 1.093 to 1.393; p=0.007) and thyroid gland (AHR, 1.389; 95 % CI, 1.121 to 1.721; p=0.0026).

Conclusion Women with GDM have a higher risk of developing cancers. Cancer screening is warranted in women with GDM. Future research should be aimed at establishing whether this association is causal.

  • gestational diabetes
  • cancer
  • national health insurance research database

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  • Contributors Y-SP proposed and designed the study. Y-SP also drafted the manuscript. M-HT supervised the study and critically edited the manuscript and finally approved the version to be submitted. J-RL designed the study’s analytic strategy and conducted the data analysis. B-HC and CH contributed the study design and prepared the Methods and the Discussion sections of the text, Y-HL and C-HS helped conduct the literature review. All authors read and approved the final manuscript.

  • Funding This work was supported by the Chang-Gung Memorial Hospital, grant number CIRPD1D0031.

  • Competing interests None declared.

  • Ethics approval This study protocol was approved by the institutional review board of Chang Gung Medical Foundation (IRB 103-2572B).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.