Hyperglycemia and Adverse Pregnancy Outcomes

Abstract

BACKGROUND It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

“…The majority of studies investigating maternal and neonatal outcomes in obesity have included obese mothers who have gestational diabetes but studies from Ireland and Denmark confirm that obesity is an independent risk factor for adverse pregnancy outcome in glucose tolerant women. [12][13][14][15] Adverse maternal outcomes…”

“…These serum markers of inflammation are associated with a poor metabolic profile, type 2 diabetes and gestational diabetes. 15,69,70 Chronic inflammation in obesity probably occurs secondary to excessive deposition of visceral fat rather than subcutaneous fat which is greater during pregnancy in women who are obese prior to conception. 71 …”

The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index

“…[1] There is now clear and unequivocal evidence that adverse pregnancy outcomes are strongly linked to maternal hyperglycaemia, both in the peri-conception period and throughout gestation. [2,3] Although strict glycemic control does improve outcomes [4], there is still a higher rate of complications in women with DM and poorer perinatal outcomes, as well as exacerbation of existing maternal comorbidities, including hypertension, thyroid disease, pre-eclampsia and eclampsia. [2,5] Given the increased risk of late pregnancy complications particularly stillbirth, some international guidelines [6] now recommend planned delivery (either caesarean birth or induction of labour) no later than 39+0 weeks gestation for pregnant women with type 1 or type 2 DM with no other complications and no later than 41+0 weeks for women with GDM.…”

Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort

“…Among non-diabetic mothers there is a linear association between fasting and postchallenge glucose and greater birth size [3]. Fuelmediated teratogenesis (also known as fetal or developmental overnutrition) has been suggested as the most likely mechanism for these associations [4,5].…”