The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Pintaudi, Basilio; Fresa, R.; Dalfrà, Mariagrazia; Dodesini, Alessandro Roberto; Vitacolonna, Ester; Tumminia, Andrea; Sciacca, Laura; Lencioni, Cristina; Marcone, Teresa; Lucisano, Giuseppe; Nicolucci, Antonio; Bonomo, Matteo; Napoli, Angela

doi:10.1007/s00592-018-1208-x

Cited by 64 publications

(67 citation statements)

References 37 publications

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“…Urinary tract infection (n = 3; 3.4%), hypoglycemia (n = 2; 2.27%), polyhydramnios (n = 2; 2.27%), vaginitis (n = 4; 4.54%), pre-eclampsia (n = 4; 4.54%) and chronic fetal distress with IUGR (n = 2; 2.27%) were the secondary outcomes identified during prenatal followups. These findings are compatible with data available in the medical literature [28][29][30][31][32]34,35].…”

Section: Discussionsupporting

confidence: 92%

“…Diabetic pregnant women presented the following primary outcomes: fetal and neonatal mortality (1.8%), macrosomia (6.81%), prematurity (16.6%) and hospitalization in neonatal ICU (9 %). All these findings presented lower rates than the ones reported in many other services [32][33][34][35]. There was an association between diabetes and prematurity and between diabetes and hospitalization in neonatal ICU (p < 0.05).…”

Section: Discussionmentioning

confidence: 56%

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Gestational and Previous Diabetes in Pregnancy: Perinatal Results

Ja¹,

Gqa²,

Pm³

et al. 2020

Asp Biomed Clin Case Rep

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Objective: Evaluating the association between gestational diabetes and fetal/maternal complications such as poor obstetric outcomes. Methods: Historical cohort comprising patients from the High-Risk Service of Federal University of Juiz de Fora (UFJF,) who were diagnosed with diabetes (exposed), as well as patients from the Low-Risk Service of UFJF (non-exposed). Data generated through anamnesis, physical examination and medical conduct, as well as data of newborns such as fetal weight, ICU admission and fetal/neonatal death), were collected and stored in the Epi Info software (version 6.0); p < 0.05. Results: 176 patients treated in the aforementioned services, 108 diabetic, and 68 non-diabetics, were investigated in the current study. In total, 92 (52.2%) of them were diagnosed with Gestational Diabetes Mellitus (GDM); 6 had DM type 1 (3.4%) and 10 had DM type 2 (5.6%). Therefore, 68 patients (38.6%) presented normal glucose metabolism. The mean age of the patients was 30.27 ± 6.77 years, the mean number of births was 1.06 ± 1.20. Macrosomia was diagnosed in 6.81% (n = 6) of the cases; it was associated with maternal glycemia (p < 0.05). D- and F-class pregnant women, who had been previously diagnosed with diabetes, presented lower fetal weight than other pregnant women (p = 0.03). Treatment was based on diet, insulin or metformin, whenever necessary. Fasting glycemia levels decreased throughout the gestational trimesters. Eighteen (10.2%) preterm fetuses were identified; 12 were born from diabetic mothers and 6 were born from non-diabetic ones (p = 0.01; X2 = 10.51). All infants hospitalized in the neonatal ICU (n = 10) were born from diabetic mothers; their mean gestational age was 36.28 + 2.9 weeks, whereas the mean gestational age of infants who were not hospitalized in the ICU was 38.31 ± 1.5 (p = 0.005; T = 12.58). Cesarean section was the most common way of delivery adopted for diabetic pregnant women (p = 0.04). Conclusion: Based on the results, gestational diabetes (GDM) is a predisposing factor to fetal macrosomia, prematurity, and hospitalization in neonatal ICUs. Pregnant women subjected to proper glycemic control in the current study presented lower complication rates in comparison to other studies in the literature.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 56%

Gestational and Previous Diabetes in Pregnancy: Perinatal Results

Ja¹,

Gqa²,

Pm³

et al. 2020

Asp Biomed Clin Case Rep

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“…The 2018 Italian STRONG study examined a cohort of comparatively older (median age: 36.8 vs. 31.0 years) and thinner (median pre‐gestational BMI: 24.8 vs. 26.5 kg/m 2 ) women and reported a similar rate of neonatal hypoglycaemia (7.2% vs. 7.8%) and a higher rate of hyperbilirubinemia (10.4% vs. 7.5%). STRONG identified maternal overweightness (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51) to be associated neonatal hypoglycaemia and did not identify any significant predictors of neonatal hyperbilirubinemia .…”

Section: Discussionmentioning

confidence: 92%

Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3‐year review

Thevarajah

Simmons

2019

Diabet. Med.

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Aim To determine risk factors associated with neonatal hypoglycaemia and hyperbilirubinaemia, and assess their impact on neonatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). Methods Retrospective review investigating all pregnancies complicated by GDM at Campbelltown Hospital (Sydney, Australia) between 1 January 2013 and 31 December 2015. Main outcomes measured were neonatal hypoglycaemia (capillary glucose levels < 1.8 mmol/l) and hyperbilirubinaemia (total serum bilirubin levels greater than age‐appropriate thresholds for phototherapy). Adjusted odds ratios [95% confidence interval (CI)] are shown, calculated by multivariable logistic regression. Results Some 60 (7.8%) infants developed hypoglycaemia, 58 (7.5%) developed hyperbilirubinaemia and 13 (1.7%) developed both. Risk of developing hypoglycaemia increased 1.8‐fold (95% CI 1.3–2.6, P < 0.001) per gestational week at GDM diagnosis, 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per mmol/l maternal fasting glucose, 6.2‐fold (95% CI 2.6–16.2, P < 0.001) with maternal history of macrosomia, 10.8‐fold (95% CI 4.1–27.6, P < 0.001) with multiple pregnancy and 1.1‐fold (95% CI 1.0–1.3, P = 0.04) per gestational week at birth. Risk of hyperbilirubinaemia increased with multiple pregnancy (26.4; 95% CI 11.7–59.7, P < 0.001), and 1.5‐fold (95% CI 1.1–2.1, P = 0.01) per gestational week at GDM diagnosis. Hypoglycaemia was associated with a 2.8‐fold (95% CI 1.1–7.1, P = 0.03) increased risk of macrosomia, a 5.4‐fold (95% CI 1.1–27.3, P = 0.04) excess risk of shoulder dystocia and a 6.4‐fold increased risk of 5‐min APGAR ≤ 7 (95% CI 1.2–1.7, P < 0.001). Hyperbilirubinaemia was associated with an excess risk of polycythaemia (packed cell volume > 0.6; 97.1, 95% CI 38.9–241.5, P < 0.001). Conclusions Neonatal hypoglycaemia and hyperbilirubinaemia largely occur in different pregnancies. Both are associated with earlier GDM diagnosis; however, hypoglycaemia is more associated with maternal glycaemia and its sequelae, and hyperbilirubinaemia is associated with polycythaemia.

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“…In addition, identification of women with characteristics such as chronic hypertension, low socio-economic status and multiparity should alert caregivers to the possibility of undiagnosed type 2 diabetes. It has been reported that pre-pregnancy obesity predicted adverse outcomes in GDM women [20]; however, due to missing data regarding pre-pregnancy obesity, we could not include obesity as a predictor in our model. No studies have looked at women with actual undiagnosed type 2 diabetes; however, one previous study compared outcomes in women with presumed undiagnosed type 2 diabetes, identified by a fasting glucose of ≥7.0 mmol/l or a 2-hour glucose of ≥11.1 mmol/l during pregnancy, with women who had early-onset GDM but were without these characteristics.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

et al. 2020

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Aim To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre‐existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. Methods This population‐based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002–2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. Results Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6–3.4]), preterm birth (OR 2.6 [2.3–2.9]), congenital anomalies (OR 2.1 [1.7–2.5]), neonatal intensive care unit admission (OR 3.1 [2.8–3.5]) and neonatal hypoglycaemia (OR 406.0 [357–461]), which were similar to women with pre‐existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. Conclusions Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre‐pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy.

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The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Abstract: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.

Cited by 64 publications

References 37 publications

Gestational and Previous Diabetes in Pregnancy: Perinatal Results

Gestational and Previous Diabetes in Pregnancy: Perinatal Results

Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3‐year review

Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

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