Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes-What Matters Most? A Retrospective Analysis.

Friederike Weschenfelder,Tanja Groten,Friederike Hein,Ekkehard Schleußner,Thomas Lehmann

doi:10.3390/jcm10020348

Friederike Weschenfelder, Tanja Groten + Show 3 more

Open Access

https://doi.org/10.3390/jcm10020348

Copy DOI

Abstract

The aim of diabetes care of pregnant women with gestational diabetes mellitus (GDM) is to attain pregnancy outcomes including rates of large-for-gestational-age (LGA) newborns, pre-eclampsia, C-sections (CS) and other neonatal outcomes similar to those of the non-GDM pregnant population. Obesity and excessive weight gain during pregnancy have been shown to also impact perinatal outcome. Since GDM is frequently associated with elevated body mass index (BMI), we evaluated the impact of maternal prepregnancy BMI, development of GDM and gestational weight gain (GWG) during pregnancy on perinatal outcome. We compared 614 GDM patients with 5175 non-diabetic term deliveries who gave birth between 2012 and 2016. Multivariate regression analysis was used to evaluate the independent contribution of each factor on selected perinatal outcome variables. Additionally, subgroup analysis for obese (BMI ≥ 30 kg/m2) and non-obese women (BMI < 30 kg/m2) was performed. LGA was significantly influenced by BMI, GWG and GDM, while Neonatal Intensive Care Unit (NICU) admission was solely impacted by GDM. Maternal outcomes were not dependent on GDM but on GWG and prepregnancy BMI. These results remained significant in the non-obese subgroup only. Thus, GDM still affects perinatal outcomes and requires further improvement in diabetic care and patient counseling.

Highlights

Awareness of gestational diabetes (GDM) and the necessity of treatment to reduce maternal and fetal complications has increased
Women with gestational diabetes mellitus (GDM) were more likely to have higher rates of large-for-gestational-age births (LGA) infants, Neonatal Intensive Care Unit (NICU) admissions, pre-eclampsia and cesarean sections (CS) compared to the non-GDM cohort
In our study, GDM patients have been compared to a cohort of non-GDM low risk term deliveries and rates of NICU admission (3.6%), preeclampsia (2.7%), CS (22.5%) and LGA (7.6%) were profoundly lower in our non-GDM

Summary

Introduction

Awareness of gestational diabetes (GDM) and the necessity of treatment to reduce maternal and fetal complications has increased. Due to several changes in the diagnostic thresholds for GDM and in conjunction with the worldwide increase in non-communicable diseases, the incidence of GDM has risen over the last few decades. The worldwide incidence of GDM is up to 11% using IADPSG (International Association of the Diabetes and Pregnancy Study Group) criteria [3]. GDM is known to be one of the major risk factors for large-for-gestational-age births (LGA) [4,5]. LGA infants are neonates that weigh at or above the 90th centile at birth adjusted to gender and gestational age at delivery. LGA deliveries are associated with prolonged labor, higher rates of cesarean sections (CS), shoulder dystocia and birth trauma [6,7]

Objectives

Methods

Results

Discussion

Conclusion