Gestational diabetes mellitus and pregnancy outcomes

Summary

A systematic review and meta-analysis «Greco E, Calanducci M, Nicolaides KH, et al. Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies: a systematic review and meta-analysis. Am J Ob»1 included 85 studies in singleton pregnancies and 27 in twin pregnancies. In singleton pregnancies with gestational diabetes (GDM), compared with controls, there were increased risks of hypertensive disorders of pregnancy (RR 1.85; 95% CI 1.69 to 2.01), induction of labor (RR 1.36; 95% CI 1.05 to 1.77), caesarean delivery (RR 1.31; 95% CI 1.24 to 1.38), large-for-gestational-age neonate (LGA) (RR 1.61; 95% CI 1.46 to 1.77), preterm birth (RR 1.36; 95% CI 1.27 to 1.46), and admission to the neonatal intensive care unit (RR 1.43; 95% CI 1.38 to 1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (RR 1.69; 95% CI 1.51 to 1.90), caesarean delivery (RR 1.10; 95% CI 1.06 to 1.13), LGA (RR1.29; 95% CI 1.03 to 1.60), preterm birth (RR 1.19; 95% CI 1.07 to 1.32), and admission to the neonatal intensive care unit (RR 1.20; 95% CI 1.09 to 1.32).

A systematic review and meta-analysis «Zhu Y, Zheng Q, Pan Y, et al. Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a syste»2 included 23 studies (18 retrospective cohort studies, 3 prospective cohort studies and 2 case control studies) involving 57 013 Chinese women with GDM. Compared with GDM women with normal weight, GDM women with overweight had higher risks of macrosomia (OR1.65, 95% CI 1.49 to 1.82, 11 studies, n=41 683), caesarean section (OR1.48, 95% CI 1.38 to 1.59, 10 studies, n=34 935), preterm birth (OR1.27, 95% CI 1.13 to 1.43, 8 studies, n=38 295) and LGA (OR1.73, 95% CI 1.54 to 1.95, 7 studies, n=31 342) and women with obesity had higher risks of macrosomia (OR 2.37, 95% CI 2.04 to 2.76, 11 studies, n=41 683), caesarean section (OR 2.07, 95% CI 1.84 to 2.32, 9 studies, n=34 829), preterm birth (OR 1.31, 95% CI 1.09 to 1.57, 8 studies, n=38 295) and LGA (OR 2.63, 95% CI 2.15 to 3.21, 6 studies, n=31 236). Compared with GDM women with sufficient GWG, GDM women with excessive GWG had higher risks of macrosomia (OR 1.74, 95% CI 1.58 to 1.92, 12 studies, n=40 966), caesarean section (OR 1.44, 95% CI 1.36 to 1.53, 9 studies, n=36 205) and LGA (OR 2.12, 95% CI 1.96 to 2.29, 12 studies, n=42 342); women with insufficient GWG conversely had higher risks of preterm birth (OR 1.59, 95 1.45 to 1.74, 9 studies, n=37 461) and SGA (OR 1.38, 95% CI 1.27 to 1.51, 10 studies, n=41 080).

A systematic review «Wendland EM, Torloni MR, Falavigna M et al. Gestational diabetes and pregnancy outcomes - a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pr»3 included 8 cohort studies with a total of 44 829 women. Gestational diabetes (GDM) was diagnosed by 2 h 75 g oral glucose tolerance test (OGTT). Only studies that applied the OGTT universally to all participants (with or without risk factors) were included. Diagnostic criteria by WHO (fasting ≥7 mmol/l [≥126 mg/dl] or 2 h plasma glucose ≥7.8 mmol/l [140 mg/dl]) and by the International Association of the Diabetes in Pregnancy Study Group (IADPSG) (fasting glucose ≥ 5.1 mmol/L [92 mg/dl], or 1 hour result of ≥ 10.0 mmol/L [180mg/dl], or 2 hour result of ≥ 8.5 mmol/L [153 mg/dl]) were used. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (birth weight over 4000g: RR 1.81, 95%CI 1.47 to 2.22; 5 trials, I²=0%); large for gestational age (defined as birthweight ≥90th percentile for gestational age: RR 1.53, 95%CI 1.39 to1.69; 4 trials; I² = 0%); pre-eclampsia (RR 1.69, 95%CI 1.31 to 2.18; 4 trials); and caesarean delivery (RR 1.37, 95%CI 1.24 to1.51; 4 trials). There was a trend towards increased perinatal mortality (RR 1.55, 95% CI 0.88 to 2.73) Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I² > 73%). Magnitudes of RRs and their 95% CIs were 1.73 (1.28 to 2.35) for large for gestational age; 1.71 (1.38 to 2.13) for pre-eclampsia; and 1.23 (1.01 to1.51) for caesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations.

A retrospective observational cohort study «Jiang S, Chipps D, Cheung WN et al. Comparison of adverse pregnancy outcomes based on the new IADPSG 2010 gestational diabetes criteria and maternal body mass index. Aust N Z J Obstet Gynaecol 2017;57»4 in Australia included 4 081 pregnant women with positive 50 g glucose challenge test but without pre-gestational diabetes. Participants were grouped into 4 cohorts: no GDM (control); GDM on Australasian Diabetes in Pregnancy (ADIPS) 1998 criteria only (treated); GDM on IADPSG 2010 criteria only (untreated); and GDM on both criteria (treated). The association of each cohort with pregnancy outcome measures, including birthweight centile, delivery gestation, primary caesarean section, shoulder dystocia and stillbirth, together with the effect of obesity, were examined. Women diagnosed with GDM according to the IADPSG 2010 (untreated) but not the ADIPS 1998 criteria (treated) had an increased risk of being LGA (OR 2.45, 95% CI 1.46 to 4.12, P = 0.001) and primary caesarean section (OR 2.03, 95% CI 1.23 to 3.35, P = 0.006) compared to control women. Among the women in this untreated group and women without GDM, obese women had an increased risk of LGA (OR 3.82, 95% CI 2.87 to 5.10, P < 0.001), shoulder dystocia (OR 1.50, 95% CI 1.03 to 2.19, P = 0.04) and primary caesarean section (OR 1.63, 95% CI 1.26 to 2.10, P < 0.001), compared to those women of normal weight.