Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

Abstract

Context:Diabetes in pregnancy (DIP) is either pregestational or gestational.Aims:To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients.Settings and Design:In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included.Subjects and Methods:The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes.Statistical Analysis Used:Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression.Results:Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia.Conclusions:Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception.

The Effects of Gestational Diabetes on Fetus: A Surveillance Study

“…Previous cesarean section history, hypertension, macrosomia, and insubstantial fetal heart tracing were the main indicators of cesarean section in GDM-affected subjects. This study confirms the findings of a previous study that changes in diet and GDM treatment through insulin, if required, drastically change the serious perinatal morbidity rate of patients and common birth issues of neonates [15]. The GDM group included in this study showed significant rates of neonatal intensive care unit (NICU) admissions (16.4%, p < 0.0003) compared to the control group, and the rate of admission was found to be slightly higher in the GDM group that was treated with insulin.…”

Associations of the dietary approaches to stop hypertension (DASH) diet with pregnancy complications in Project Viva

“…Each of these cardiovascular (blood pressure) and metabolic (glycemia, weight status) traits impact a woman’s risk for pregnancy complications. For example, pre-pregnancy obesity, excess weight gain during pregnancy, and history of elevated blood pressure are risk factors for hypertensive disorders of pregnancy ( 16 ), preterm birth ( 17 ), and small-for-gestational age ( 17 , 18 ); and poor glycemic control is a determinant of gestational diabetes, preterm delivery, and large-for-gestational age ( 19 ). Yet, little is known regarding the influence of the DASH diet during pregnancy, an important timeframe for short- and long-term health of both the mother and infant.…”

Hypertriglyceridaemia in pregnancy: an unexpected diagnosis and its management

“…Strict diabetic control is essential to prevent adverse maternal and fetal outcomes such as pre-eclampsia, polyhydramnios, macrosomia and neonatal intensive care unit admission. 13 Women should be counselled to restrict their consumption of high glycaemic index foods including refined sugar and high-fructose beverages. Total daily fat should be less than 20% of total caloric intake but may require further restriction depending on TG levels.…”