What Is the Cost of Reducing Adverse Pregnancy Outcomes in Patients With GDM: A Retrospective Cohort Study

Abstract

Background Gestational diabetes mellitus is a frequent complication of pregnancy, affecting the health of mothers and their offspring. The new diagnostic strategy for GDM, proposed by IADPSG in 2010 and WHO in 2013, raised hope for a reduction in perinatal complications. The purpose of the study was to evaluate factors influencing obstetric results in a group of women diagnosed with diabetes, regardless of the adopted diagnostic criteria, compared to a group of pregnant women in whom GDM was excluded. Methods It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the period from 2013 to 2015. All pregnant women had a 75g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for obstetric complications for patients with gestational diabetes to a group of women without GDM. The impact was analysed of the aforementioned factors on maternal and paediatric obstetric outcomes. Results The parameters significantly influencing the risk of composite adverse maternal outcomes were the circumference of the pregnant woman’s abdomen [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk of this complication by almost half [OR: 0.47 (0.30; 0.75). The size of the maternal abdominal circumference before delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire examined cohort. A circumference over 100 cm increased the risk of at least one pregnancy complication (increased blood loss, soft tissue injuries, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001). Conclusions Apart from normalization of glycaemia, stabilization of the percentage of adipose tissue and non-glycaemic obstetric risk factors may be necessary to obtain further improvement in obstetric outcomes in this pregnant population.