Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland

Abstract

Aims The aim of this study was to investigate the association between previous induced abortion or miscarriage and the development of gestational diabetes mellitus (GDM) using high-quality register data. Methods In this retrospective nationwide register-based cohort study, data from the national medical birth register (MBR) were used to evaluate the association between a history of miscarriage or induced abortion and GDM. We included all first pregnancies ending in delivery in which the oral glucose tolerance test was performed between 2004 and 2018. A logistic regression model was used to assess the development of GDM in the first pregnancy ending in delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (Cis) were compared between groups. Results In total, 15,873 nulliparous women with a history of induced abortions, 22,337 with a history of miscarriages and 3594 with a history of both were found. The reference group consisted of 138,869 women without a history of induced abortions or miscarriages. Women with a history of induced abortions (24.7%, aOR 1.15 [CI 1.11–1.20]), a history of miscarriages (24.8%, aOR 1.14 [CI 1.10–1.18]) and a history of both (27.7% aOR 1.18 [CI 1.09–1.28]) had higher odds for the development of GDM when compared to the reference group (20.8%). The odds for GDM increased along with the increasing number of previous induced abortions and miscarriages. Conclusion Women with a history of induced abortions or miscarriages had higher odds for GDM in their first pregnancy leading to birth. Knowledge of this association will be helpful in the prevention and screening of GDM.

Clinical Profile and Outcome of Infant of Diabetic Mother in a Tertiary Care Centre

“…In the meta-analysis done by Wang et al, they included 31 studies with 311,900 subjects and compared GDM to non-GDM mothers where they found the prevalence of lost parity was higher in mothers with GDM and thus concluded that the occurrence of fetal loss is significant for the occurrence of GDM. 15 Similar findings were identified by Zhao et al and Vaajala et al 16,17 The majority of the mothers, 57 (72.15%) were on a diabetic diet. This is a common diabetic control method recommended by several guidelines for the control of diabetes in pregnancy.…”

Diabetic and hypertensive disorders following early pregnancy loss: a systematic review and meta-analysis

“…For women who had a prior IA, 17 , 30 , 33 , 59 , 60 there was a small increased risk of gestational diabetes mellitus in subsequent pregnancies, with effects ranging from aOR 1.03 (95% CI 0.97–1.10) 59 to aOR 1.18 (95% CI 1.12–1.24). 17 Three studies 17 , 59 , 60 were included in a meta-analysis, producing a pooled aOR of 1.04 (95% CI 0.97–1.12, I 2 = 89.6%), indicating that women who had a prior IA did not have increased odds of developing gestational diabetes mellitus in subsequent pregnancy ( Supplementary Figure S1 ). Of the six studies 41 , 42 , 45 , 48 , 62 , 75 that examined the association between RPL and gestational diabetes mellitus effects ranged from an aOR of 0.69 (95% CI 0.47–1.02) to aOR 1.69 (95% CI 1.10–2.59).…”

“…Ten studies were marked as high risk of bias, six 41 , 42 , 43 , 44 , 45 , 46 of which failed to control for adequate confounding variables and four 47 , 48 , 49 , 50 which failed to sufficiently define their exposure variables. 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 Thirteen studies 14 , 17 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 were deemed to be of moderate risk of bias, with 16 studies deemed to be of low risk of bias 16 , 18 , 33 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ( Fig. 2 ).…”

“…Among 12 studies that provided effect estimates for the risk of subsequent gestational diabetes mellitus following a previous early pregnancy loss, most reported an increase in effect estimate from weak to strong, with adjusted odds ratio (aOR) ranged from 1.05 (95% 0.80–1.37) to a 5.05 (95% 2.65–9.63) for women who had experienced a prior SAB. Nine studies 17 , 44 , 47 , 48 , 49 , 59 , 60 , 62 , 73 that examined the association between SAB and gestational diabetes mellitus reported adjusted effect estimates and were deemed eligible for inclusion in the meta-analysis. The pooled estimates of these studies showed that women who experienced a previous SAB had 44% increased odds of developing gestational diabetes mellitus in a subsequent pregnancy (pooled OR 1.44; 95% CI 1.23–1.68) ( Fig.…”