Comparison of pregnancy outcomes between women with early‐onset and late‐onset gestational diabetes in a retrospective multi‐institutional study in Japan

Abstract

Aims/IntroductionTo compare pregnancy outcomes between women with gestational diabetes mellitus (GDM) diagnosed early and late in pregnancy in Japan.Materials and MethodsWe examined women diagnosed with GDM in this multi‐institutional retrospective study. Women were divided into two groups by gestational age at diagnosis: <24 weeks of gestation (early group, 14.4 ± 4.2 weeks) and ≥24 weeks of gestation (late group, 29.6 ± 3.4 weeks). Dietary counseling with self‐monitoring of blood glucose with or without insulin therapy was initiated for both groups. Pregnancy outcomes were compared between the groups.ResultsData from 600 early and 881 late group participants from 40 institutions were included. Although pre‐pregnancy body mass index was higher in the early group than in the late group, gestational weight gain was lower in the early group. Hypertensive disorders of pregnancy and cesarean section were more prevalent in the early than in the late group (9.3% vs 4.8%, P < 0.001; 34.2% vs 32.0%, P < 0.001, respectively). The prevalence of large‐for‐gestational‐age infants was higher in the late than in the early group (24.6% vs 19.7%, respectively, P = 0.025). There was no significant difference in other neonatal adverse outcomes between the groups. Multiple logistic regression analysis showed that early group, nulliparity and pre‐pregnancy body mass index were associated with hypertensive disorders of pregnancy.ConclusionsThese results suggest that maternal complications, including hypertensive disorders of pregnancy and cesarean delivery, were higher in the early group than in the late group. Earlier intervention for GDM might be associated with a reduction in large‐for‐gestational‐age infants.

Proportion of abnormal second 50‐g glucose challenge test in gestational diabetes mellitus screening using the two‐step method in high‐risk pregnant women

“…Not only LGA but also non‐reassuring fetal status which were indication for cesarean section and found more in late‐onset GDM (7.0% vs 2.1%, P = 0.447), leading to more fetal asphyxia (APGAR at 5 min < 7), neonatal resuscitation and neonatal intensive care unit (NICU) admission (4.7% vs 2.1%, P = 0.980, 14% vs 4.5%, P = 0.005 and 9.3% vs 6.3%, P = 0.162, consecutively). In contrast to this study, those results were not similar to studies in 2017 (NICU 34.2% vs 36.2%, P = 0.491) and 2019 (comparison of NICU admission and RDS between early‐ and late‐onset GDM; RR 1.16 [0.90, 1.49] and RR 1.00 [0.76, 1.32], respectively) …”

“…With the mean of 29 weeks of gestation at diagnosis in this study, maybe that it was too aggressive to start insulin without any trial of diet‐control and life‐style modification within 3 weeks. This was similar to recent retrospective multi‐institutional study in 2019 that they could not achieve good glycemic control until delivery (diagnosed at almost 30 weeks of gestation) and also found more LGA infants and fetal macrosomia in late‐onset GDM (24.6% vs 19.7%, P = 0.025 and 3.4% vs 2.2%, P = 0.348, consecutively). Maternal and neonatal adverse outcomes are directly associated with the degree of hyperglycemia .…”

Pregnancy outcomes among multi‐ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake

“…Previous studies comparing women with early and late GDM have shown a higher risk of adverse outcomes among those diagnosed early 12–14 . Meanwhile, comparable pregnancy outcomes between the two groups were reported in another retrospective study which were thought to be due to early recognition and management 15 .…”

Evaluation of Pregnancy Outcomes among Women with Pregnancies Complicated by Diabetes Mellitus in Abakaliki, South-East, Nigeria

“…We found that the incidence of diabetes in pregnancy was 6.6 per 1000 deliveries (0.66%). This finding was lower than the values that were reported in other African countries [11] [12] [13]. A systematic review of six countries in Africa estimated the overall prevalence of GDM to be 5%; however, there is variability due to the availability of screening procedures and diagnostic criteria [14].…”