Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment
Open Access
- 5 December 2015
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 39 (1), 75-81
- https://doi.org/10.2337/dc15-0433
Abstract
OBJECTIVE Recent guidelines recommend testing at RESEARCH DESIGN AND METHODS Outcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at n = 68), at 12–23 weeks of gestation (n = 1,247), or at ≥24 weeks of gestation (n = 3,493). RESULTS Hypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at CONCLUSIONS Despite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.Keywords
This publication has 30 references indexed in Scilit:
- Body Composition Is Normal in Term Infants Born to Mothers With Well-Controlled Gestational Diabetes MellitusDiabetes Care, 2013
- The Hyperglycemia and Adverse Pregnancy Outcome StudyDiabetes Care, 2012
- International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in PregnancyDiabetes Care, 2010
- A Multicenter, Randomized Trial of Treatment for Mild Gestational DiabetesNew England Journal of Medicine, 2009
- First-Trimester Fasting Hyperglycemia and Adverse Pregnancy OutcomesDiabetes Care, 2009
- Gestational diabetes: the need for a common groundThe Lancet, 2009
- Maternal and neonatal outcomes in early glucose tolerance testing in an obstetric population in New York cityjpme, 2009
- Sociodemographic Correlates of the Increasing Trend in Prevalence of Gestational Diabetes Mellitus in a Large Population of Women Between 1995 and 2005Diabetes Care, 2008
- Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes MellitusDiabetes Care, 2008
- Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based studyBMJ, 2006