Relationship between threatened miscarriage and gestational diabetes mellitus

Hee Joong Lee,Errol Norwitz,Banghyun Lee

doi:10.1186/s12884-018-1955-2

Abstract

BackgroundBoth threatened miscarriage and gestational diabetes mellitus (GDM) are common complications of pregnancy. However, only one pilot study has reported that these complications are not related. We aimed to investigate whether threatened miscarriage is one of the risk factors of GDM.MethodsAn unmatched case-control study of 1567 pregnant Korean women who underwent a two-step approach to diagnose GDM was retrospectively conducted. The eligible women were classified into normal (n = 840), borderline GDM (n = 480), and GDM (n = 247) groups. We analyzed the associations with threatened miscarriage in all groups with adjustment for confounding factors.ResultsThe proportion of women who experienced threatened miscarriage was significantly lower in the GDM group than in the normal group (adjusted odds ratio (OR), 0.38; 95% confidence interval (CI), 0.18–0.78). It was significantly lower in the maternal hyperglycemia group (borderline GDM and GDM groups) than in the normal group (adjusted OR, 0.66; 95% CI, 0.47–0.91). The proportion of women who experienced threatened miscarriage was also significantly lower in the GDM group than in the normal (adjusted OR, 0.35; 95% CI, 0.17–0.70) and borderline GDM groups (adjusted OR, 0.46; 95% CI, 0.22–0.94). Moreover, the proportion of women who experienced threatened miscarriage significantly decreased according to the severity of glucose intolerance (adjusted OR, 0.94; 95% CI, 0.76–1.16).ConclusionThis study demonstrates that threatened miscarriage is associated with decreased risk of GDM and the severity of glucose intolerance in Korean women. Additional studies are warranted to understand the pathophysiologic mechanisms that might exist between these frequent complications of pregnancy.

Highlights

Both threatened miscarriage and gestational diabetes mellitus (GDM) are common complications of pregnancy
The maternal hyperglycemia group exhibited a lower incidence of intrauterine hematoma and SGA, and a lower gestational age at birth than the normal group
The preterm delivery, cesarean section, preeclampsia, history of prior GDM, and pre-pregnancy Body mass index (BMI) were higher in the maternal hyperglycemia

Summary

Introduction

Both threatened miscarriage and gestational diabetes mellitus (GDM) are common complications of pregnancy. Threatened miscarriage, which is defined as any vaginal bleeding that occurs during the first half of a pregnancy, occurs in an estimated 14–20% of all pregnant women (14.8% in Korean women) [1, 2]. Bleeding that originates from the uteroplacental vessels between the chorionic membrane and the uterine wall is often considered to be the most common cause of vaginal bleeding in threatened miscarriage [3]. Depending on the severity of bleeding, Maternal hyperglycemia occurs when insulin secretion from pancreatic β cells is inadequate for the increased insulin requirements during pregnancy [7]. Gestational diabetes mellitus (GDM) is defined as any severity of maternal hyperglycemia with onset or first recognition during pregnancy [8, 9].

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