Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women

Cosson, E.; Vicaut, Éric; Sandre‐Banon, D.; Gary, Françoise; Pharisien, I.; Portal, Jean-Jacques; Banu, I.; Bianchi, Luigi; Cussac‐Pillegand, C.; Dina, Riska Silpia; Chiheb, S.; Valensi, P.; Carbillon, Lionel

doi:10.1016/j.diabet.2018.11.006

Cited by 29 publications

(47 citation statements)

References 45 publications

(88 reference statements)

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“…We have shown for the first time that initially untreated eFHG has a worse prognosis in women with GDM even after treatment; therefore, eFHG diagnosis appears to be crucial in screening women who are going to develop GDM as earlier treatment of hyperglycaemia in pregnancy might limit the occurrence of GDM‐related events, even if this has not yet been proven .…”

Section: Discussionmentioning

confidence: 98%

“…It was based on the electronic medical records of women delivering at this hospital, where obstetrical data are routinely collected at birth by the midwife assisting with the delivery . In addition, we collected data on GDM screening .…”

Section: Participants and Methodsmentioning

confidence: 99%

“…Women were informed that their medical records could be used for research, unless they opposed this . The data were analysed anonymously.…”

Section: Participants and Methodsmentioning

confidence: 99%

“…to an oblique angle, rotation of the infant by 180°, delivery of the posterior arm); and neonatal hypoglycaemia, defined as at least one blood glucose value < 2.0 mmol/l during the first 2 days of life [17]. We also considered each of the previous events separately, as well as caesarean sections; small-for-gestational-age infant; preterm delivery; offspring hospitalization; respiratory distress syndrome; intrauterine fetal or neonatal death; any malformation and hyperbilirubinaemia [15]. We also considered gestational weight gain during pregnancy and need for insulin at the time of delivery [15].…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

“…However, two studies showed that, despite no initial intervention, < 50% of women with eFHG actually developed GDM after 24 weeks’ gestation . Furthermore, early screening for eFHG might not reduce complications . Lastly, to our knowledge, no study has explored the prognosis of untreated eFHG according to the further development of GDM.…”

Section: Introductionmentioning

confidence: 99%

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Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks’ gestation: a case–control study

et al. 2019

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Aims To evaluate the percentage of women with untreated fasting hyperglycaemia in early pregnancy who develop gestational diabetes mellitus after 22 weeks’ gestation, the determinants of gestational diabetes development in such women and the prognosis of early fasting hyperglycaemia according to whether the women go on to develop gestational diabetes. Methods From a large cohort of women who delivered in our hospital between 2012 and 2016, we retrospectively selected all those who had untreated early fasting hyperglycaemia and separated them into a ‘gestational diabetes’ and a ‘no‐gestational diabetes’ group according to oral glucose tolerance test results after 22 weeks’ gestation. We compared the incidence of a predefined composite outcome (preeclampsia or large‐for‐gestational‐age infant or shoulder dystocia or neonatal hypoglycaemia) in both groups. Results A total of 268 women (mean fasting plasma glucose 5.3 ± 0.3 mmol/l at a mean ± sd of 10.2 ± 4.2 weeks’ gestation) were included. Gestational diabetes developed in 134 women and was independently associated with early fasting plasma glucose ≥ 5.5 mmol/l [odds ratio 3.16 (95% CI 1.57, 6.33)], age ≥ 30 years [odds ratio 2.78 (95% CI 1.46, 5.31)], preconception obesity [odds ratio 2.12 (95% CI 1.11, 4.02)], family history of diabetes [odds ratio 1.87 (95% CI 1.00, 3.50)] and current employment [odds ratio 0.46 (95% CI 0.26, 0.83)]. Despite treatment, gestational diabetes induced a significant increase in the composite outcome as compared to no gestational diabetes (odds ratio 2.16 [95% CI 1.08, 4.34]). The association disappeared after adjustment for risk factors. Conclusions Only half of the women with early fasting hyperglycaemia and no specific care subsequently developed gestational diabetes, and these women had a poor prognosis despite gestational diabetes treatment. Poor prognosis was mostly attributable to risk factors. Our results suggest that only women with certain risk factors should be screened for early fasting hyperglycaemia.

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Section: Discussionmentioning

confidence: 98%

Section: Participants and Methodsmentioning

confidence: 99%

“…Women were informed that their medical records could be used for research, unless they opposed this . The data were analysed anonymously.…”

Section: Participants and Methodsmentioning

confidence: 99%

Section: Pregnancy Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks’ gestation: a case–control study

et al. 2019

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Diagnosis of Gestational Diabetes Mellitus

Wolffenbuttel

2022

Comprehensive Clinical Approach to Diabetes During Pregnancy

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Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018

Regnault,

Lebreton,

Tang

et al. 2024

Diabetologia

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Aims/hypothesis We aimed to assess maternal–fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. Methods We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22–30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm–Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. Results The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22–30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm–Bonferroni adjustment for deliveries at ≥31 GW using GDM22–30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb’s palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb’s palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm–Bonferroni adjustment. Conclusions/interpretation Compared with GDM22–30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal–fetal outcomes. Graphical Abstract

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Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women

Cited by 29 publications

References 45 publications

Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks’ gestation: a case–control study

Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks’ gestation: a case–control study

Diagnosis of Gestational Diabetes Mellitus

Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018

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