High macrosomia risk with early gestational diabetes diagnosis
medwireNews: Women who are diagnosed with gestational diabetes within the first 24 weeks of pregnancy are at particularly high risk for delivering a baby that is large for its gestational age, say researchers.
This was despite women with an early gestational diabetes diagnosis giving birth significantly earlier, on average, than those with later diagnoses, at 37.7 versus 38.4 weeks’ gestation, report Maisa Feghali (University of Pittsburgh School of Medicine, Pennsylvania, USA) and co-researchers.
Of the 167 women with an early diagnosis, 12.6% delivered a baby with macrosomia, compared with 7.0% of the 1202 who were diagnosed after at least 24 weeks of pregnancy. The team accounted for differences in baseline characteristics between the two groups by matching 128 women with early diagnoses and 1098 women with later diagnoses on variables associated with diagnosis at less than 24 weeks’ gestation, but a twofold difference persisted among these women, at macrosomia rates of 14.8% versus 7.8%.
In the whole cohort, women with early diagnoses also had increased risks for adverse outcomes including hypertensive disorders of pregnancy, neonatal intensive care unit admission, and respiratory distress syndrome, but these associations lost significance after propensity score matching.
Matching accounted for pre-pregnancy BMI, as well as factors including previous gestational diabetes; age, race, and education; and chronic hypertension, the researchers note in Diabetes Research and Clinical Practice.
Women with early gestational diabetes diagnoses were less likely to gain excess weight during pregnancy than those with later diagnoses, “suggesting that nutritional counseling earlier in gestation impacts maternal behavior,” says the team.
“However, these differences in weight gain were insufficient to reduce the risk for macrosomia.”
The analysis also accounted for glucose levels during pregnancy, which were higher in women with early diagnoses. They more often required antidiabetic medication, of which glyburide was the most common, given to 66.7% and 56.9% of women with early and later diagnoses, respectively. And among women given glyburide, those diagnosed before 24 weeks more frequently progressed to insulin by the end of pregnancy, compared with those diagnosed later, at 27.7% versus 3.0%.
The association of early diagnosis with macrosomia persisted within these treated women, at 18.8% versus 9.0%.
“There is a paucity of data regarding optimal glycemic targets for high-risk women with diabetes in pregnancy, and it is possible that different glycemic targets or alternate therapeutic approaches are needed in this population,” say the researchers.
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