Abstract
Aims/hypothesisThe aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.MethodsAll deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.ResultsThe cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother–infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).Conclusions/interpretationGDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.
Highlights
The proportions of overweight and obese women are rising in the general population worldwide [1]
After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth, Caesarean section, pre-eclampsia/eclampsia, macrosomia, respiratory distress, birth trauma and cardiac malformations were increased in women with gestational diabetes mellitus (GDM) compared with the non-diabetic population
The aims of this study were to: (1) estimate the prevalence of GDM in pregnant women in 2012 in France; (2) assess perinatal outcomes after 22 weeks of pregnancy in the presence of GDM compared with pregestational diabetes or no diabetes; (3) determine whether perinatal outcomes differed according to whether GDM was treated by insulin or diet alone; and (4) increase the validity of conclusions by controlling for immortal time bias and contamination by data from women with undiagnosed pregestational diabetes
Summary
The proportions of overweight and obese women are rising in the general population worldwide [1]. The consequences of pregestational diabetes have been recognised for a long time, the association between less severe glucose intolerance and morbidity was not definitively proven prior to the publication of findings from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study [4]. Data on GDM derived from exhaustive national or regional databases that link maternal and neonatal outcomes are relatively rare [5,6,7,8], and the overall risk of morbidity of neonates born to GDM mothers remains unclear, for neonates with congenital malformations and respiratory distress [9]. Two problems usually make data interpretation more difficult in GDM studies: (1) the so-called immortal time bias; and (2) the possible contamination of GDM data by inclusion of women with undiagnosed pregestational diabetes, who may be reclassified after pregnancy
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