The Influence of Preeclampsia, Advanced Maternal Age and Maternal Obesity in Neonatal Outcomes Among Women with Gestational Diabetes

Abstract

Objective The present study aims to analyze adverse fetal or neonatal outcomes in women with gestational diabetes, including fetal death, preterm deliveries, birthweight, neonatal morbidity and mortality, as well as the synergic effect of concomitant pregnancy risk factors and poor obstetric outcomes, as advanced maternal age, maternal obesity and pre-eclampsia in their worsening. Methods The present cohort retrospective study included all pregnant women with gestational diabetes, with surveillance and childbirth at the Hospital da Senhora da Oliveira during the years of 2017 and 2018. The data were collected from the medical electronic records registered in health informatic programs Sclinico and Obscare, and statistical simple and multivariate analysis was done using IBM SPSS Statistics. Results The study participants included 301 pregnant women that contributed to 7.36% of the total institution childbirths of the same years, in a total of 300 live births. It was analyzed the influence of pre-eclampsia coexistence in neonatal morbidity (p = 0.004), in the occurrence of newborns of low and very low birthweight (p < 0.01) and in preterm deliveries (p < 0.01). The influence of maternal obesity (p = 0.270; p = 0.992; p = 0.684) and of advanced maternal age in these 3 outcomes was also analyzed (p = 0,806; p = 0.879; p = 0.985).Using a multivariate analysis, the only models with statistic significance to predict the three neonatal outcomes included only pre-eclampsia (p = 0.04; p < 0.01; p < 0.01). Conclusion Only coexistence of pre-eclampsia showed an association with adverse neonatal outcomes (neonatal morbidity, newborns of low and very low birthweight and preterm deliveries) and can be used as a predictor of them in women with gestational diabetes.

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

“…PE is the main cause of maternal and fetal mortality and morbidity (19,20). GDM complicated by PE further increases perinatal adverse events (21)(22)(23)(24), future maternal risk of chronic hypertension, cardiovascular disease, and diabetes (25)(26)(27); offspring body mass index (BMI) also steadily increases over time (28). Identifying factors associated with occurrence of PE in women with GDM, especially those that are controllable, is important for improving pregnancy outcomes.…”

The Impact of Coexisting Gestational Diabetes Mellitus on the Course of Preeclampsia

“…Nunes et al investigated the influence of PE, advanced maternal age, and maternal obesity on neonatal outcomes in patients with GDM. They found that among these three factors, only the coexistence of PE showed an association with adverse neonatal outcomes, such as neonatal morbidity, low and very low birthweight, and preterm delivery [ 24 ]. To our knowledge, there is only one study comparing perinatal outcomes in patients with hypertensive disorders of pregnancy (HDP) with and without GDM.…”

“…The risk of developing PE in patients with GDM has been, up to date, widely studied [ 22 , 23 , 24 , 25 ]. PE and GDM share several risk factors, such as advanced maternal age, nulliparity, multiple pregnancy, ethnicity, and pregestational obesity.…”

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“…IMT pregestasional merupakan faktor risiko terjadinya komplikasi maternal dan perinatal. 8 Peningkatan IMT ibu dikaitkan dengan luaran peningkatkan biaya perawatan kebidanan, termasuk peningkatan angka persalinan dengan seksio sesarea, morbiditas ibu, penggunaan neonatal intensive care unit (NICU), dan lama perawatan di rumah sakit. 9 Obesitas ibu juga dikaitkan dengan peningkatan risiko morbiditas neonatal seperti kelahiran pada usia kehamilan <33 minggu, berat lahir > 4000 g, cedera lahir, skor Apgar yang lebih rendah, sindrom gangguan pernapasan, sepsis bakteri, kejang neonatal, dan hipoglikemia.…”

“…9 Obesitas ibu juga dikaitkan dengan peningkatan risiko morbiditas neonatal seperti kelahiran pada usia kehamilan <33 minggu, berat lahir > 4000 g, cedera lahir, skor Apgar yang lebih rendah, sindrom gangguan pernapasan, sepsis bakteri, kejang neonatal, dan hipoglikemia. 8,9 Preeklamsia dan obesitas pada wanita hamil masing-masing secara independen terkait dengan hasil neonatal yang lebih buruk, memiliki kedua faktor tersebut dapat menunjukkan peningkatan tingkat hasil neonatal yang lebih buruk dibandingkan dengan adanya obesitas atau preeklamsia saja. 9 Namun kurangnya data mencakup kombinasi hal ini di Rumah Sakit Hasan Sadikin membuat peneliti tertarik melakukan penelitian untuk mempelajari kombinasi kehadiran obesitas dan preeklamsia pada wanita hamil terhadap luaran bayi dan lama perawatan di Rumah Sakit Hasan Sadikin periode 1 Januari 2015 -30 November 2019.…”