Pregnancy and Neonatal Outcomes in Gestational Diabetes Treated with Regular Insulin or Fast-Acting Insulin Analogues

To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (α level of 0.05; two-tailed). The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92-29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79-3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95-1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92-6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53-2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84-2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42-1.26; P=.29) compared with group 2. Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. II.

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal complications, including preterm delivery, macrosomia, and neonatal hypoglycemia. Elevated serum ferritin levels, a marker of inflammation and oxidative stress, may exacerbate these risks. This study was aims to determine if serum ferritin elevation is a marker of adverse maternal and fetal outcome in pregnancies complicated by GDM. Method: A case control study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College, Dhaka from September 2020 to August 2021. 42 pregnant women at 2nd 3rd trimester attended for antenatal care diagnosed as GDM was selected as cases and 42 non-diabetic pregnant women matching with cases by age and gestational age was selected as control are included this study. GDM was diagnosed by oral glucose tolerance test (OGTT). The serum ferritin level of these patients was measured. Results: Elevated serum ferritin was significantly associated with GDM (p<0.05). GDM women had higher rates of obesity (p=0.005), preterm delivery (30.9% vs. 16.6%) and term delivery was less in case group (69.05%) than controls (83.33%) . In neonates of GDM mothers macrosomia rates were 26.19% in case group and 14.3% in control group. Hypoglycemia was 16.6%, respiratory distress 11.9% and NICU admissions 21.4% (p<0.05 vs controls). Conclusion: Elevated serum ferritin is a strong predictor of adverse maternal and neonatal outcomes in GDM pregnancies. These findings suggest that ferritin could serve as a biomarker for identifying high-risk pregnancies. Incorporating ferritin screening into antenatal care may facilitate early risk stratification and targeted interventions.

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

In pregnant women, obesity is a risk factor for multiple adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), preeclampsia, and preterm birth. The aim of this study was to determine the effects of pre-pregnancy body mass index (BMI) on maternal and neonatal outcomes in women with GDM. A retrospective study of 5010 patients with GDM in 11 provinces in China was performed in 2011. Participants were divided into three groups based on BMI as follows: a normal weight group (BMI 18.5–23.9 kg/m2), an overweight group (BMI 24–27.9 kg/m2), and an obese group (BMI ≥28.0 kg/m2). Maternal baseline characteristics and pregnancy and neonatal outcomes were compared between the groups. Multiple logistic regression analysis was used to explore the relationships between BMI and the risk of adverse outcomes. Of the 5010 GDM patients, 2879 subjects were from north China and 2131 were from south China. Women in the normal weight group gained more weight during pregnancy compared with the overweight and obese GDM patients. Women in the overweight and obese groups had increased odds of hypertension during pregnancy (adjusted odds ratio (AOR) = 1.50, 95 % confidence interval (CI) = 1.31–1.76 and AOR = 2.12, 95 % CI = 1.84–3.16). The AORs for macrosomia in the overweight and obese groups were 1.46 (95 % CI = 1.16–1.69) and 1.94 (95 % CI = 1.31–2.98), respectively. The relative risk of delivering a baby with an Apgar score <7 at 5 min was significantly higher in women who were obese (AOR = 2.11, 95 % CI = 1.26–2.85) before pregnancy compared with normal weight women. Compared with the normal weight subjects, the incidence of cesarean section and emergency cesarean section among overweight and obese women with GDM was significantly higher (P < 0.001). Overall, overweight and obese women with GDM have an increased risk of adverse outcomes, including hypertension during pregnancy, macrosomic infants, infants with low Apgar scores, and the need for an emergency cesarean section. More attention should be paid to GDM women who are obese because they are at risk for multiple adverse outcomes.

To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes. A total of 4090 cases, who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks, from January. 1(st), 2011 to Jul 31(st), 2012 , were divided into 2 groups. Normal blood glucose group:the result of OGTT (fasting plasma glucose, 1 hour glucose and 2 hour glucose ) was normal; Gestational diabetes mellitus group (GDM group): the result of OGTT was abnormal at any time point. GDM group were separated into A, B and C. GDM A means fasting plasma glucose annormal but others were normal, GDM B:fasting plasma glucose, 1 hour and/or 2 hour glucose abnormal, GDM C:fasting plasma glucose normal. To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes, GDM group were divided into I, II and III.GDMI means one abnormal blood glucose of OGTT result, GDM II: two abnormal blood glucose and GDM III:three abnormal blood glucose. We analyzed the pregnant outcomes of each group. (1) Among the 4090 cases, 858 cases (21.98%) were diagnosed as GDM (GDM group), and 82 cases (9.6%, 82/858) were treated with insulin.other 3232 cases with normal blood glucose (normal blood glucose group). In GDM group, the rate of cesarean section (51.9%, 445/858), premature delivery (8.4%, 72/858) and LGA (5.9%, 51/858) were respectively significantly higher than those of normal blood glucose group [ (43.5%, 1406/3232), (5.8%, 189/3232) and(4.2%, 137/3232)] (P < 0.05). But, there was no statistically significant differences for the rate of macrosomia (P > 0.05) between the GDM group(6.8%, 58/858) and normal blood glucose group (6.2%, 199/3232) . (2) In the GDM group, GDM A was 317 cases (36.9%), GDM B 239 cases (27.8%), GDM C 302 cases (35.2%). The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P < 0.05). Comparing with GDM A , there was no statistically significance in GDM B and GDM C (P > 0.05). (3) In GDM group, GDMIwas 521 cases (60.7%), GDM II203 cases (15.6%), GDM III 134 cases (23.7%). Compared with the normal blood glucose group, GDM III had a significantly higher incidence of macrosomia and LGA and cesarean section(P < 0.01);and GDM IIhad only a significantly higher incidence of cesarean section(P < 0.01). (4) Among the 4090 cases, there were 1118 patients (27.3%) whose fasting blood glucose was below 4.4 mmol/L, of which 55 cases were diagnosed as GDM. There were 4 premature infants and 1 macrosomia. The GDM group with more than FBG ≥ 5.1 mmol/L had a higher incidence of adverse pregnancy outcomes, it suggested that we should pay more attention and take actively intervented; the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

ObjectiveTo investigate the change of maternal characteristics, delivery and neonatal outcomes in gestational diabetes mellitus (GDM) over recent 10 years and to identify the risk factors associated with adverse outcome.MethodsConsecutive GDM patients (n=947) delivered in our institution were included. Research period was arbitrarily divided into 2 periods (period 1: from 2006 to 2010, period 2: from 2011 to 2015). Multiple pregnancies or preexisting diabetes were excluded. Maternal baseline characteristics, delivery and neonatal outcomes were reviewed. Fetal biometric findings by prenatal ultrasonography were collected. Adverse pregnancy outcome (APO) was defined by the presence of one of the followings; shoulder dystocia, neonatal macrosomia (>4 kg), neonatal hypoglycemia (<35 mg/dL), respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU) in term pregnancy.ResultsPeriod 2 was associated with older maternal age (34 vs. 33, P<0.001) and higher proportion of GDM A2 compared to period 1 (30.9% vs. 23.0%, P=0.009). By univariate analysis, APO was associated with increased body mass index (BMI) at pre-pregnancy (23.4 kg/m2 vs. 21.8 kg/m2, P=0.001) or delivery (27.9 kg/m2 vs. 25.8 kg/m2, P<0.001), higher HbA1c at diagnosis (5.6% vs. 5.3%, P<0.001) or delivery (5.8% vs. 5.5%, P=0.044), and larger fetal biometric findings (abdominal circumference [AC] and estimated fetal weight, P=0.029 and P=0.007, respectively). Multivariate analysis showed pre-pregnancy BMI (odds ratio [OR], 1.101; 90% confidence interval [CI], 1.028–1.180) and fetal AC (OR, 1.218; 90% CI, 1.012–1.466) were independently associated with adverse outcomes.ConclusionOur study demonstrated the trends and relevant factors associated with the adverse outcomes.

Diabetes and Pregnancy

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The impact of gestational diabetes mellitus (GDM) complicated with preeclampsia (PE) on perinatal outcomes in twin pregnancies, particularly across different GDM subtypes, remains unclear. This case-control study included 1,263 twin pregnancies with GDM and categorized participants as follows: (i) GDM without PE and GDM with PE groups, and (ii) GDM subgroups based on oral glucose tolerance test (OGTT) values at different time points, including GDM-IFH, GDM-IPH, and GDM-CH. Initially, the study investigated risk factors for PE occurrence in women with GDM. Subsequently, univariate and multivariate logistic regression analyses were conducted to explore the impact of GDM with PE on perinatal outcomes in twin pregnancies compared to GDM without PE. Stratified analyses and interaction effects were also examined to assess the risk of adverse perinatal outcomes in GDM twin pregnancies with various maternal characteristics combined with PE. Additionally, the study assessed the influence of aspirin on the GDM with PE group. Based on OGTT values, the study further investigated their impact on perinatal outcomes in the GDM with PE group and examined the influence of different GDM subtypes on perinatal outcomes in twin pregnancies with GDM and PE. Baseline characteristics of twin pregnancies with GDM indicated that pre-pregnancy BMI (PBMI) (p < 0.001), weight gain during pregnancy (p < 0.001), nulliparity (p = 0.029), and the use of IVF (p = 0.023) may be risk factors for the occurrence of PE in GDM. Additionally, GDM with PE increased the risk of Intrahepatic Cholestasis of Pregnancy (ICP) (OR 2.00), hypoproteinemia during pregnancy (OR 4.18), anemia during pregnancy (OR 2.34), and MICU admission (OR 5.43) compared to GDM without PE. Regarding neonatal outcomes, the GDM with PE group had significantly higher risks of neonatal hyperbilirubinemia (OR 1.97), preterm labor (OR 1.58), and NICU admission (OR 2.32). In the GDM with PE group, aspirin significantly reduced the risk of preterm labor. Further research indicated that glucose values significantly affected the occurrence of ICP, hypoproteinemia during pregnancy, and anemia during pregnancy in the GDM with PE group. Subgroup analysis based on OGTT glucose values classified GDM subtypes showed that different GDM subtypes are closely related to the risk of hypoproteinemia during pregnancy, neonatal hyperbilirubinemia, and preterm labor in both GDM without PE group and GDM with PE groups. Particularly in GDM-IPH and GDM-CH subtypes, PE combined with GDM significantly increased the risks associated with ICP, hypoproteinemia during pregnancy, and MICU admission. Moreover, GDM-IPH combined with PE significantly increased the risks of anemia during pregnancy, NICU admission, and neonatal hyperbilirubinemia, while GDM-CH combined with PE also significantly increased the risk of preterm birth. Twin pregnancies with GDM complicated by PE are associated with an increased risk of adverse perinatal outcomes, closely related to the subtypes of GDM. However, the use of aspirin has been shown to significantly reduce the risk of preterm birth in twin pregnancies with GDM and PE.

With no current randomized trials, we explored the impact of tight compared with standard treatment targets on pregnancy outcomes in gestational diabetes mellitus (GDM). This cohort study of singleton births ≥ 28 weeks' gestation was conducted at two major Australian maternity services (2009-2013). Standardized maternal, neonatal and birth outcomes were examined using routine healthcare data and compared for women with GDM at Service One (n = 2885) and Service Two (n = 1887). Services applied different treatment targets: Service One (standard targets, reference group) fasting < 5.5 mmol/l, 2-h postprandial < 7.0 mmol/l; Service Two (tight targets) fasting < 5.0 mmol/l, 2-h postprandial < 6.7 mmol/l. Multivariable regression with propensity score adjustment was used to examine associations between targets and outcomes. GDM prevalence and insulin use were 7.9% and 31% at Service One, and 5.7% and 46% at Service Two. There were no differences in primary outcomes: birthweight > 90th centile [adjusted odds ratio (OR) 1.06, 95% confidence interval (CI) 0.87-1.30] and < 10th centile (OR 0.84, 95% CI 0.70-1.01), or secondary outcomes gestational hypertension, pre-eclampsia, shoulder dystocia or a perinatal composite. Service Two with tight targets had increased induction of labour (OR 3.63, 95% CI 3.17-4.16), elective Caesarean section (OR 1.75, 95% CI 1.37-2.23) and Apgar scores < 7 at 5 min (OR 1.54, 95% CI 1.05-2.25), decreased hypoglycaemia (OR 0.76, 95% CI 0.61-0.94]), jaundice (OR 0.47, 95% CI 0.35-0.63) and respiratory distress (OR 0.68, 95% CI 0.47-0.98). Tight GDM treatment targets were associated with greater insulin use and no difference in primary birthweight outcomes. The service with tight targets had higher obstetric intervention, lower rates of reported hypoglycaemia, jaundice, respiratory distress and lower Apgar scores. High-quality interventional data are required before tight treatment targets can be implemented.

New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population. The Atlantic Diabetes In Pregnancy (DIP) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24–28 weeks. GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and compared with previous WHO criteria; maternal and neonatal adverse outcomes were prospectively recorded. Of the participants, 12.4% and 9.4% were diagnosed with GDM using IADPSG and WHO criteria, respectively. IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes (gestational hypertension, polyhydramnios and Caesarean section) and neonatal outcomes (prematurity, large for gestational age, neonatal unit admission, neonatal hypoglycaemia and respiratory distress). The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age, body mass index and non-European ethnicity. Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes. GDM prevalence is higher when using newer IADPSG, compared with WHO, criteria, and these women and their offspring experience significant adverse pregnancy outcomes. Higher rates of GDM pose a challenge to healthcare systems, but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child.

Perinatal Maternal and Neonatal Outcomes in Women With Gestational Diabetes Mellitus According to Fetal Sex

The specific influence of the pre-pregnancy body mass index (PPBMI) on women with gestational diabetes mellitus (GDM) is unclear. Our objective was to investigate how PPBMI categories affect pregnancy and neonatal outcomes in women with GDM. A retrospective cohort study was conducted using data from patients attending the Fujian Maternity and Child Health Hospital (Fuzhou, China) from 2021 to 2023. The participant records were stratified into four groups according to their BMI values: underweight, normal-weight, overweight, and obese. The pregnancy and neonatal outcomes for these BMI categories were analyzed using multivariable logistic regression. The study included data from 2,909 pregnant women diagnosed with GDM. Underweight women with GDM showed significantly lower risks of pregnancy-induced hypertension (PIH) (adjusted OR, 0.26) and cesarean sections (adjusted OR, 0.55) but higher risks of low body weight (LBW) infants (adjusted OR, 3.40). Overweight and obese women experienced higher risks of PIH (adjusted OR, 2.96), cesarean sections (adjusted OR, 1.62), and macrosomia (adjusted OR, 1.43). PPBMIs significantly impact pregnancy outcomes in women with GDM. Both underweight and overweight/obese categories are associated with adverse outcomes, highlighting the need for pre-pregnancy counseling and interventions to achieve and maintain a healthy BMI.

Background: Gestational diabetes mellitus is prevailing among pregnant females and affects the pregnancy outcome both in neonate and mother. As Pakistan is having high incidence of diabetes mellitus so females are at high risk of developing gestational diabetes mellitus (GDM). Other factors that may lead to GDM include age of female, weight, family history, previous history or family history of diabetes, stillbirths, previous history of large gestation and other socio-demographic factors. Whatever the risk factors are, the outcome of pregnancy in females with gestational diabetes is related to increased cesarean section, hyperglycemia and hypertension in mothers. Hypoglycemia is just after birth, macrosomia and large gestation in neonates. In order to determine risk factors and association of GDM with pregnancy outcome we have conducted this study with future implications for better pregnancy outcome. Methodology: An analytical study was conducted at the department of Gynae &amp; Obs, Al-Nafees Medical College and Hospital, Islamabad for a period of one year and 9 months starting from July 2019 to March 2021. All the pregnant females diagnosed with gestational diabetes during their checkup in hospital visits were included in study through convenient sampling. The socio-demographic and laboratory data was obtained from their file record and pregnancy outcome was observed at the time of delivery in the same hospital. The analysis was done for 150 females by using SPSS version 26. Continuous variables were analyzed by mean and standard deviation while categorical variables were determined by frequencies in percentage. Outcome of pregnancy was analyzed by macrosomia, hypoglycemia in neonates and cesarean, hypertension in mothers. The association was determined between GDM and pregnancy outcome by chi-square test of significance where p &lt;0.05. Results: In our study 150 females were of mean age 33.91 with ±3.72 SD. The mean self-reported, pre-pregnancy BMI(Kg/m2) of all pregnant females was 29.89 with ±4.55 SD. The mean number of children born to females was 3.4. There is no significant association of gestational period with neonatal or maternal death p- value was 0.308 and 0.410 respectively by applying chi-square test (p&lt;0.05). The gestational diabetes mellitus is associated with cesarean section as 78(52%) females underwent elective c-section. Among these females 84(56%) developed hypertension and 18(21%) were managed for eclampsia. Neonates born with macrosomia were 48 (32%) and with hypoglycemia just after birth were 89 (59.3%). Keywords: Gestational diabetes mellitus (GDM), Outcome of pregnancy, Macrosomia, Neonatal hypoglycemia, Maternal hypertension.

Context: There are little data on the prevalence of thyroid autoimmunity in gestational diabetes mellitus (GDM) and its influence on pregnancy outcomes. Aims: The aims were to estimate the prevalence of thyroid autoimmunity in euthyroid GDM and to compare the pregnancy outcomes in euthyroid antithyroid peroxidase antibody (TPOAb)-positive women to TPOAb-negative women and to compare the pregnancy outcomes across the euthyroid range of thyroid-stimulating hormone (TSH). Design: This is an observational, prospective cohort study. Subjects and Methods: One hundred women with GDM with euthyroid status were recruited. Samples were analyzed for TSH, free T4, and TPOAb. Women with TPOAb positivity were considered as cases and with TPOAb negativity were controls. Pregnancy outcomes assessed were pregnancy-induced hypertension (PIH), preterm delivery, cesarean section, birth weight, birth asphyxia, neonatal jaundice, hypoglycemia, seizures, and stillbirths. Statistical Analysis: Student t-test and Chi-square test were used to compare the mean values between the groups and differences between proportions, respectively, and P Results: The prevalence of TPOAb positivity in euthyroid GDM was 14%. Pregnancy outcomes between cases and controls were similar except for neonatal jaundice (42.9% vs. 18.5%), which was statistically significant (P = 0.04). PIH occurred in 28.6% and 25.6% in cases and controls, respectively. There was no significant difference in maternal and neonatal outcomes across euthyroid range of TSH. Conclusion: The prevalence of TPOAb positivity in euthyroid GDM was similar to the nondiabetic pregnant women. Neonatal jaundice was more in TPOAb-positive women. Pregnancy outcomes were comparable across the euthyroid range in GDM, suggesting similar range as those without GDM. There is no influence of thyroid autoimmunity on pregnancy outcomes in GDM in the present study.