Borderline gestational diabetes mellitus and pregnancy outcomes
Open Access
- 30 July 2008
- journal article
- clinical trial
- Published by Springer Nature in BMC Pregnancy and Childbirth
- Vol. 8 (1), 31
- https://doi.org/10.1186/1471-2393-8-31
Abstract
Background The impact of borderline gestational diabetes mellitus (BGDM), defined as a positive oral glucose challenge test (OGCT) and normal oral glucose tolerance test (OGTT), on maternal and infant health is unclear. We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes. Methods We compared demographic, obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS) who had BGDM and who screened negative on OGCT. Results Women who had BGDM were older (mean difference 1.3 years, [95% confidence interval (CI) 0.3, 2.2], p = 0.01) and more likely to be obese (27.1% vs 14.1%, relative risk (RR) 1.92, [95% CI 1.41, 2.62], p < 0.0001) than women who screened negative on OGCT. The risk of adverse maternal outcome overall was higher (12.9% vs 8.1%, RR 1.59, [95% CI 1.00, 2.52], p = 0.05) in women with BGDM compared with women with a normal OGCT. Women with BGDM were more likely to develop pregnancy induced hypertension (17.9% vs 11.8%, RR 1.51, [95% CI 1.03, 2.20], p = 0.03), have a caesarean for fetal distress (17.1% vs 10.5%, RR 1.63, [95% CI 1.10, 2.41], p = 0.01), and require a longer postnatal hospital stay (mean difference 0.4 day, [95% CI 0.1, 0.7], p = 0.01) than those with a normal glucose tolerance. Infants born to BGDM mothers were more likely to be born preterm (10.7% vs 6.4%, RR 1.68, [95% CI 1.00, 2.80], p = 0.05), have macrosomia (birthweight ≥4.5 kg) (4.3% vs 1.7%, RR 2.53, [95% CI 1.06, 6.03], p = 0.04), be admitted to the neonatal intensive care unit (NICU) (6.5% vs 3.0%, RR 2.18, [95% CI 1.09, 4.36], p = 0.03) or the neonatal nursery (40.3% vs 28.4%, RR 1.42, [95% CI 1.14, 1.76], p = 0.002), and have a longer hospital stay (p = 0.001). More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy (12.9% vs 7.8%, RR 1.65, [95% CI 1.04, 2.63], p = 0.03). Conclusion Women with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT. Intervention strategies to reduce the risks for these women and their infants need evaluation. Trial registration Current Controlled Trials ISRCTN00416244Keywords
This publication has 19 references indexed in Scilit:
- Screening for gestational diabetes: The effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomesAustralian and New Zealand Journal of Obstetrics and Gynaecology, 2007
- Gestational diabetes: The consequences of not treatingAmerican Journal of Obstetrics and Gynecology, 2005
- Increasing Prevalence of Gestational Diabetes Mellitus (GDM) Over Time and by Birth CohortDiabetes Care, 2005
- ACOG Practice Bulletin #55: Management of Postterm PregnancyObstetrics & Gynecology, 2004
- Population Health Significance of Gestational DiabetesDiabetes Care, 2003
- Gestational Diabetes and the Incidence of Type 2 DiabetesDiabetes Care, 2002
- Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetesAmerican Journal of Obstetrics and Gynecology, 1995
- Intensified versus conventional management of gestational diabetesAmerican Journal of Obstetrics and Gynecology, 1994
- RISK-FACTORS FOR SHOULDER DYSTOCIA1985
- Neonatal Morbidity Among Infants of Diabetic MothersDiabetes Care, 1978