Maternal and fetal outcomes in women with cerebrovascular malformations in pregnancy: A multicentre retrospective cohort study

Cauldwell, Matthew; Bredaki, Emma; Dassan, Pooja; Dhanjal, Mandish; Kaler, Mandeep; Madipola, Nissanka; Mahmud, Mohammad A.; Paviour, Dominic; Senvar, Naz; Silva, Rajith de; Watt-Coote, Ingrid; Williams, David; Yulia, Angela; Steer, Philip

doi:10.1111/1471-0528.17046

Cited by 2 publications

(5 citation statements)

References 24 publications

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“…Interestingly, the GDM >30 group had the lowest percentage of women requiring insulin (10%). This finding warrants further studies to understand whether the lower rate of insulin prescription could explain the higher rate of LGA infants in women with GDM >30 compared with those with GDM 22–30 , as previously reported [ 9 ].…”

Section: Discussionsupporting

confidence: 66%

“…undetected cases may have relatively mild GDM). Moreover, GDM cases can be identified late in pregnancy in cases of polyhydramnios or macrosomia diagnosed on ultrasound (GDM >30 in the present study) [ 7 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 96%

“…In our cohort, approximately 90% of women with GDM >30 were screened at least once before 30 GW. These women were probably retested following the diagnosis of macrosomia or polyhydramnios on ultrasound despite their previous screening results being normal [ 7 , 9 , 10 ]. The remaining women (10%) may have been diagnosed after 30 GW because of ultrasound abnormalities or because they did not follow the recommended screening schedule earlier in pregnancy if they had risk factors for hyperglycaemia in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of normal laboratory test results, a 75 g OGTT is recommended between 24 and 28 gestational weeks (GW). GDM screening may also occur outside the screening schedule if ultrasound examinations identify macrosomia or polyhydramnios later in pregnancy [ 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…As the prognostic value of early- and late-diagnosed GDM remains unclear [ 9 – 11 , 13 , 14 ], we conducted a large-scale national observational study using data from the French National Health Data System (Système National des Données de Santé, SNDS). The aims of the study were: (1) to estimate the proportion of each subtype of hyperglycaemia in pregnancy among all hyperglycaemic pregnant women in France in 2018; and (2) to compare the prognoses of those with normoglycaemic status, early-diagnosed GDM, late-diagnosed GDM and overt diabetes with women diagnosed with GDM between 22 and 30 GW (GDM 22–30 ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 96%