Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening.

Erin Clarke,Shaun Brennecke,Thomas J Cade

doi:10.1155/2020/9083264

Erin Clarke, Shaun Brennecke + Show 1 more

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https://doi.org/10.1155/2020/9083264

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Abstract

The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks (n = 133) and “Late GDM” diagnosed from 24 weeks (n = 636). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, p = 0.02). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.

Highlights

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance less than overt diabetes first detected during pregnancy [1]
Ere is a paucity of evidence examining the outcomes of high-risk women who are screened early and test positive for GDM. e International Association of the Diabetes and Pregnancy Study Groups (IADPSG) formulated current diagnostic criteria to standardise GDM screening globally, based on associations between hyperglycemia and adverse outcomes in women >24 weeks gestation [2]. ese criteria are used for early screening despite a lack of evidence to support this [9]
Over the 12 month period of the study, 793 women with GDM delivered. e final sample included 769 women a er exclusions for overt diabetes in pregnancy according to WHO criteria (16), incomplete documentation (2), and multiple pregnancy (6). e final sample was grouped as Early GDM (푛 = 133) and Late GDM (푛 = 636). 17.3% of women with GDM were diagnosed before 24 weeks gestation, at an average gestation of 17 weeks (±5.2 weeks)

Summary

Introduction

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance less than overt diabetes first detected during pregnancy [1]. In Australia, it is recommended to conduct universal screening for GDM between 24–28 weeks gestation, using a 75 g 2 hour oral glucose tolerance test (OGTT) [8]. High-risk women (defined by Australasian Diabetes in Pregnancy Society (ADIPS) risk factors, such as previous GDM, BMI >35 kg/m2, or age ≥40 years) are recommended to receive early screening before 24 weeks [8]. Ere is a paucity of evidence examining the outcomes of high-risk women who are screened early and test positive for GDM. E International Association of the Diabetes and Pregnancy Study Groups (IADPSG) formulated current diagnostic criteria to standardise GDM screening globally, based on associations between hyperglycemia and adverse outcomes in women >24 weeks gestation [2].

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