Background Gestational diabetes mellitus (GDM) is glucose intolerance diagnosed during pregnancy. We aimed to explore the different outcomes of women with two consecutive pregnancies with GDM. Methods This study included 861 women with recurrent GDM who had two consecutive singleton deliveries at Fujian Maternity and Child Health Hospital between May 2012 and September 2020. Data on pregnancy complications and neonatal and delivery outcomes were collected and analyzed. Results Among those women with recurrent GDM, there was no difference in pregnancy complications in index pregnancy vs subsequent pregnancy. Our data revealed there was a significantly higher incidence of thyroid disease in the subsequent pregnancies than in the index pregnancy. (6% vs 10%, p = .003)In subsequent pregnancies, the birth weight was greater than that of the index pregnancy (3296.63 ± 16.85 vs 3348.99 ± 16.05, p = .025); and the incidence of large for gestational age (LGA) was higher than that of the index pregnancy (16.3% vs 20.6%, p = .021). More cesarean sections occurred in the subsequent pregnancy. (32.9% vs 6.6%, p = .039). Postpartum hemorrhage, premature birth, and placental abruption were not significantly different between the two pregnancies. Conclusions The results suggest the effect of GDM on thyroid dysfunction may be persistent. Recurrent gestational diabetes results in a higher rate of cesarean delivery, incidence of LGA, and neonatal admission to the neonatal intensive care unit (NICU) in subsequent pregnancies. We need to pay attention to the postpartum thyroid function of pregnant women with GDM. Further studies are still needed on recurrent GDM to reduce this occurrence of admission to NICU.
Objective To explore the risk factors and perinatal outcomes of re-recurrent gestational diabetes mellitus (GDM). Methods A retrospective cohort study of women with recurrent GDM who had two consecutive singleton deliveries was performed in Fujian Maternity and Child Health Hospital from January 1, 2012 and December 31, 2021. Datas on pregnancy characters and complications, neonatal and delivery outcomes were collected and analyzed. Results (1) In total, 712 women were included and followed up. 90 women were excluded due to lack of oral glucose tolerance test after six weeks of postpartum and 13 women were lost in the follow up. As of the date of data cutoff, 94 women got third pregnancy and 46 of them delivered after 24 weeks . Among these 46 women , 32 (71.11%) complicated with GDM (case group) , 10 (21.74%) uncomplicated with GDM ( control group) and the other 4 (8.70%) women complicated with pre-gestational diabetes mellitus (PGDM) in the third pregnancy . (2) There was no significant difference in age, lover age, qualifications, gravidity, parity, mode of conception, history of macrosomia , pre-pregnancy BMI and gestational weight gain between two groups (all P˃0.05). Interpregnancy interval (IPI) (months) to first (55.03±5.79 vs 69.10±3.14, P=0.000) and second (25.78±6.75 vs 41.30±5.95, P=0.000) pregnancy were significantly shorter in case group than control group. (3) OGTT 0 hPG and OGTT 1hPG during second pregnancy , TG before second delivery and FPG in first trimester showed no significant difference between two groups (all P˃0.05) . OGTT 2 hPG (8.94±1.25 vs 7.91±1.12, P=0.026 ), number of OGTT abnormal items (1.91±0.77 vs 1.40±0.52, P=0.027) , TC before second deliveryand glycosylated (6.82±1.03 vs 6.10±0.73, P=0.046) and hemoglobin A1c (HbA1c) in second trimester (5.62±0.39 vs 5.33±0.20, P=0.031) and before delivery (5.72±0.38 vs 5.13±0.30, P=0.000) during second pregnancy was significantly higher in case group than control group . TG (2.29±0.54 vs 1.85±0.41, P=0.021) and TC (5.12±0.67 vs 3.92±0.30, P=0.000) in first trimester and FPG before delivery (5.12±0.74 vs 4.17±0.38, P=0.000) was significantly higher in case group than control group. (4) There was no significant difference in the hospitalization days and expenses, gestational age, mode of delivery ,Apgar score at 1 min, weight of fetus and the rate of hypertensive disorders in pregnancy (HDP) , intrahepatic cholestasis of pregnancy (ICP), premature rupture of membranes (PROM) , precipitate labor, postpartum hemorrhage (PPH) , small for gestational age (SGA) between two groups (all P˃0.05). The rate of hypothyroidism in (34.38% vs 0%, P=0.31) case group were significantly higher than control group. The rate of large for gestational age (LGA) (28.13% vs 0%, P=0.058) and admission to NICU (34.38% vs 10.00%, P=0.14) in case group were higher than control group, but there was no statistically difference.Conclusions Perinatal care for women with history of GDM especially recurrent GDM must be started before pregnancy and after delivery. It is recommended to choose the appropriate length of IPI and control the plasm level of lipid and glucose to minimize the high risk of re-recurrent GDM . The management of plasm lipid and glucose still need to be further strengthened and studied to improve the prognosis of perinatal outcomes.
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