Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Feghali, Maisa; Abebe, Kaleab Z.; Comer, Diane; Caritis, Steve N.; Catov, Janet M.; Scifres, Christina

doi:10.1016/j.diabres.2018.02.004

Cited by 37 publications

(33 citation statements)

References 39 publications

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“…When differences in maternal characteristics and glycemic control were adjusted, there is still a higher risk of preeclampsia in earlier diagnosis group (odds ratio, 2.4; 95% CI, 1.5, 3.8). Similar results were reported in the study of Maisa N et al [16]. In contrast with women who received a diagnosis for GDM at or after 24 weeks, women diagnosed with GDM before 24 weeks were associated with an increased risk for macrosomia (OR 2, 95% 1-4.15, p = 0.0498), but relationship with other adverse outcomes was not found.…”

Section: Discussionsupporting

confidence: 88%

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

Z¹,

Shan²,

C³

et al. 2020

Preprint

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Background Gestational diabetes mellitus (GDM) is a common pregnancy-induced metabolic complication worldwide. At present, a variety of strategies for diagnosis and management of GDM have been recommended. Our aim is to investigate the clinical features and pregnancy outcomes among women in whom a first-trimester fasting glucose value (≥ 5.10 mmol/L but < 7.0 mmol/L) was detected and a 2-h 75-g oral glucose tolerance test (OGTT) between 24–28 weeks was negative.Methods This is a prospective cohort study of women who registered and delivered between June 2016 and November 2019 at First Hospital, Jilin University. Pregnant women who met the inclusion criteria were categorized as normal first-trimester fasting plasma glucose(FPG)(< 5.10 mmol/L) and first-trimester fasting hyperglycemia (≥ 5.10 mmol/L but < 7 mmol/L).Outcomes included weeks at time of delivery, neonatal birth weight, Apgar score at 1 min, Apgar score at 5 min, prevalence of macrosomia, hypertensive disorders of pregnancy ,primary cesarean delivery, preterm delivery ,premature rupture of membranes and sillbirth or neonatal death were compared after women who developed gestational diabetes mellitus (GDM) were excluded.Results In our population of 2124 eligible subjects, pregnant women with first-trimester fasting hyperglycemia (≥ 5.10 mmol/L but < 7 mmol/L) constituted 20.8% of the total study population and accounted for 27.6% of subsequent GDM diagnosis. The other 1683 had a normal first-trimester FPG (< 5.1 mmol/L), accounting for 11.6% of all subsequent GDM diagnosis (p < 0.01).After excluding women with a diagnosis of GDM between 24 and 28 weeks of gestation, we observed no significant difference between groups for adverse maternal and prenatal outcomes.Conclusion More than two thirds of first-trimester fasting hyperglycemia pregnant women will have a normal OGTT performed at 24–28 week and of these women whom in no increased risk of adverse pregnancy outcomes have been identified.

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Section: Discussionsupporting

confidence: 88%

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

Z¹,

Shan²,

C³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…However, the authors of the IOM guidelines predicted difficulties identifying the causal ordering between GWG and disorders that develop during pregnancy, like GDM, and also advised that conditions diagnosed early in pregnancy and managed effectively, may have reduced risk. As predicted, studies evaluating the effect of GWG on GDM has been shown risks to be both increased [23] and decreased [24] The Committee also accurately predicted that treatment for the condition would alter the pattern of weight gain after diagnosis [25, 26]. More recent studies have evaluated GWG prior to early screening and shown that early in pregnancy, increased GWG does precede the diagnosis of GWG [27–29].…”

Section: Discussionmentioning

confidence: 99%

An evaluation of whether a gestational weight gain of 5 to 9 kg for obese women optimizes maternal and neonatal health risks

Thompson

2019

BMC Pregnancy Childbirth

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Background Maternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m 2 was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes. Methods Data containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain. Results Obese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes. Conclusions Obese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate. Electronic supplementary material The online version of this article (10.1186/s12884-019-2273-z) contains supplementary material, which is available to authorized users.

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“…Several studies have examined these adverse outcomes of high-risk women [12][13][14][15][16][17]. A recent Australian study concluded that despite early diagnosis, high-risk women suffered higher rates of preterm delivery, cesarean delivery, preeclampsia, and macrosomia, even a er excluding diabetes in pregnancy [12].…”

Section: Discussionmentioning

confidence: 99%

Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening

Clarke

Cade

Brennecke

2020

Journal of Pregnancy

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The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks (n=133) and “Late GDM” diagnosed from 24 weeks (n=636). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, p=0.02). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.

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Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Abstract: Women diagnosed with GDM before 24 weeks have unique features, are at risk for adverse outcomes, and require targeted approaches to therapy.

Cited by 37 publications

References 39 publications

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

An evaluation of whether a gestational weight gain of 5 to 9 kg for obese women optimizes maternal and neonatal health risks

Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening

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Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Abstract: Women diagnosed with GDM before 24 weeks have unique features, are at risk for adverse outcomes, and require targeted approaches to therapy.

Cited by 37 publications

References 39 publications

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China

An evaluation of whether a gestational weight gain of 5 to 9 kg for obese women optimizes maternal and neonatal health risks

Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening

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Abstract: Women diagnosed with GDM before 24 weeks have unique features, are at risk for adverse outcomes, and require targeted approaches to therapy.