Nationwide study confirms risks of gestational diabetes
medwireNews: Research using a national database confirms a moderately increased risk for adverse maternal and neonatal outcomes if pregnancy and delivery are complicated by gestational diabetes.
The risk was lower than if women had pre-existing diabetes at the time of conception, however.
As reported in Diabetologia, Sophie Jacqueminet (Pitié-Salpêtrière Hospital, Paris, France) and co-researchers used a nationwide French database, giving them access to data from 796,346 deliveries that occurred in 2012, of which 7.24% involved women with a diagnosis of gestational diabetes.
Overall, all adverse outcomes except for nervous system malformations occurred at a higher rate if women had gestational diabetes than if they had no diabetes, among the 88.5% of deliveries for which both maternal and neonatal outcome data were available.
For example, the eclampsia/preeclampsia rates were 2.6% versus 1.6%, macrosomia 15.7% versus 9.2%, and cardiac malformation rates were 0.9% versus 0.7%, although rates were markedly higher again if the women had pre-existing type 1 or type 2 diabetes.
The associations persisted when the analysis was restricted to deliveries that occurred after 28 weeks’ gestation (when gestational diabetes is commonly diagnosed) and at term (from week 37), after accounting for maternal age.
However, the researchers caution that they had no information about glycemic control during pregnancy, or other complications that could have contributed to adverse outcomes, such as increased maternal body mass index.
They also found that the risk for some outcomes was particularly high if the mother’s gestational diabetes required insulin treatment, relative to non–insulin-treated diabetes, with the risks for preterm delivery, Cesarean section, macrosomia, and cardiac abnormalities all significantly increased.
Among term deliveries, gestational diabetes also appeared to be associated with an increased risk for perinatal mortality, although the team stresses that the rate was still very low, at 0.21% versus 0.15% in the absence of diabetes.
After excluding women who may have had undiagnosed pregestational diabetes, increased perinatal mortality was restricted to babies of women whose diabetes did not require insulin treatment, which the researchers say is “difficult to explain,” although they speculate it could be related “to longer exposure to hyperglycaemia, as we found that non-insulin-treated women with [gestational diabetes] had a later term of delivery compared with insulin-treated women.”
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