Is vaginal progesterone treatment associated with the development of gestational diabetes? A retrospective case\u2013control study

Klara Rosta,Theresa Reischer,Johannes Ott,Tobias Lahner,Fanni Kelemen,Aniko Somogyi,Wilhelm Temsch,Hanns Helmer

doi:10.1007/s00404-018-4895-1

Abstract

PurposeTo determine the incidence of gestational diabetes mellitus (GDM) in pregnant women who received vaginal progesterone due to short cervical length or to prevent recurrent preterm birth.MethodsIn this retrospective study, we included 190 women with singleton pregnancies at risk for preterm birth who received vaginal natural progesterone (200 mg daily between gestational weeks 16 + 0 and 36 + 0) for a minimum of 4 weeks and delivered > 28 weeks. The control group consisted of 242 age- and body mass index (BMI)-matched patients without progesterone administration. Data were acquired from a database containing prospectively collected information. Patients with pre-existing diabetes, and conception after in vitro fertilisation procedure were excluded.ResultsThe incidence of GDM did not differ significantly between the progesterone-treated and the control group (14.7% vs. 16.9%, respectively; p = 0.597). In a binary regression model, patients with higher pre-pregnancy BMI (OR 1.1; p = 0.006), and those with a family history of diabetes had a higher risk for GDM development (OR 1.8; p = 0.040), whereas vaginal progesterone treatment had no significant influence (p = 0.580).ConclusionThe use of vaginal progesterone for the prevention of recurrent preterm delivery and in women with a short cervix does not seem to be associated with an increased risk of GDM.

Highlights

Gestational diabetes mellitus (GDM), defined as glucose intolerance, first recognized during pregnancy is one of the most common complications during pregnancy
We found no other difference in patient and pregnancy parameters between the two groups
No differences in the incidence of GDM were found between progesterone-treated and control women: neither in those with a body mass index (BMI) 20.0–24.9 kg/m2 (6/77, 7.8% vs. 15/103, 14.5%, respectively; p = 0.162), nor in those with a BMI 25.0–29.9 kg/m2 (9/40, 22.5% vs. 13/57, 22.8%, respectively; p = 0.972), nor in those with a BMI ≥ 30 kg/ m2 (7/26, 26.9% vs. 20/42, 47.6%, respectively; p = 0.090). In this retrospective case–control study, the use of vaginal progesterone was not associated with an increased risk of GDM development

Summary

Introduction

Gestational diabetes mellitus (GDM), defined as glucose intolerance, first recognized during pregnancy is one of the most common complications during pregnancy. Increasing trends in the prevalence of GDM have been reported in several Western countries, mainly attributed to delayed maternal age at pregnancy as well as to the obesity epidemic. This seems reasonable since advanced maternal age at pregnancy, prepregnancy overweight or obesity belongs to the most important risk factors for GDM [3]. Progestogens (including synthetic progesterone analogues and natural progesterones) are used worldwide to prevent preterm birth, a leading cause of perinatal mortality and morbidity. The use of either synthetic or natural progestogens as a measure to prevent preterm birth has increased substantially in the last several

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