Obstetrical outcomes in patients with early onset gestational diabetes

Gupta, Simi; Dolin, Cara D.; Jadhav, Ashwin; Chervenak, Judith; Timor‐Tritsch, I. E.; Monteagudo, Ana

doi:10.3109/14767058.2014.991711

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…Consistent with our findings, women with presumed undiagnosed type 2 diabetes were more often multiparous. These women also had a higher baseline HbA 1c and more often had a glucose challenge test ≥11.1 mmol/l [12]. In another study, women diagnosed with GDM of <12 weeks gestation were compared with women with preexisting diabetes [11].…”

Section: Discussionmentioning

confidence: 99%

“…Although other studies have not looked at the outcomes of women specifically with undiagnosed type 2 diabetes, several studies have compared women with GDM diagnosed early (<24 weeks gestation) with those diagnosed in the usual time. Women diagnosed with GDM of <24 weeks gestation tended to be older, were more likely to be multiparous, had a higher BMI, and reported a family history of diabetes [12]. In a recent meta-analysis of 13 cohort studies comparing outcomes in early vs. late-onset GDM, women diagnosed earlier had higher perinatal mortality and neonatal hypoglycaemia, and required more insulin [13].…”

Section: Discussionmentioning

confidence: 99%

“…In our large, population-based study in Ontario using administrative data, we found that 3.7% of women with GDM were diagnosed with type 2 diabetes in the first 9 months post-delivery [6]. While there is considerable evidence that women with pre-existing type 2 diabetes have a much higher likelihood of experiencing adverse pregnancy outcomes compared with women with GDM and healthy women [4,5,[7][8][9][10], and several studies have described the outcomes of women with an early GDM diagnosis [11][12][13], none have described the characteristics of Correspondence to: Denice Feig. E-mail: d.feig@utoronto.ca women with actual undiagnosed type 2 diabetes and their pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 92%

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Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

et al. 2020

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Aim To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre‐existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. Methods This population‐based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002–2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. Results Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6–3.4]), preterm birth (OR 2.6 [2.3–2.9]), congenital anomalies (OR 2.1 [1.7–2.5]), neonatal intensive care unit admission (OR 3.1 [2.8–3.5]) and neonatal hypoglycaemia (OR 406.0 [357–461]), which were similar to women with pre‐existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. Conclusions Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre‐pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

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Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

et al. 2020

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“…Two other studies have compared the treatment outcomes between women with eGDM and preexisting diabetes. Both studies found that results in the eGDM group despite early diagnosis and treatment approximated those seen with preexisting DM [ 115 , 116 ].…”

Section: Interventional Studies In Egdmmentioning

confidence: 99%

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

et al. 2021

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Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.

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“…However, there is a lack of data on mental health outcomes during pregnancy and in the postpartum in women with eGDM. Concerning metabolic health in the postpartum period, we are aware of a few, mostly retrospective studies that showed higher rates of abnormal glucose tolerance in the postpartum in women diagnosed with eGDM compared to cGDM (22)(23)(24). However, the overall low postpartum testing rates of around 50% limit the interpretation of their findings and they do not comment on cardiovascular risk factors.…”

Section: Introductionmentioning

confidence: 99%

Cardiometabolic and Mental Health in Women With Early Gestational Diabetes Mellitus: A Prospective Cohort Study

Quansah

Gross

Gilbert

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes. Objective We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM. Methods This prospective cohort included 1185 All women with cGDM and 76 women with eGDM. The eGDM group had GDM risk factors (BMI >30 kg/m2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age, and diagnosed using American Diabetes Association prediabetes criteria. All women underwent lifestyle adaptations. Obstetric, neonatal, mental, and cardiometabolic outcomes were assessed during pregnancy and postpartum. Results The eGDM group had lower gestational weight gain than cGDM (10.7 ± 6.2 vs 12.6 ± 6.4; P = 0.03) but needed more medical treatment (66% vs 42%; P < 0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%; P = 0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (P ≤ 0.001). In eGDM, the postpartum prevalence of the metabolic syndrome (MetS) was 1.8-fold, prediabetes was 3.1-fold, and diabetes was 7.4-fold higher than cGDM (waist circumference-based MetS: 62% vs 34%/BMI-based MetS: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all P < 0.001). These differences remained unchanged after adjusting for GDM risk factors. Conclusion Compared with cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM risk factors and gestational weight gain. This hints to a preexisting risk profile in eGDM.

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Obstetrical outcomes in patients with early onset gestational diabetes

Abstract: Most patients diagnosed with early onset gestational diabetes do not have undiagnosed type 2 diabetes but do have unique characteristics and obstetrical outcomes.

Cited by 6 publications

References 7 publications

Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population‐based cohort study in Ontario, Canada

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

Cardiometabolic and Mental Health in Women With Early Gestational Diabetes Mellitus: A Prospective Cohort Study

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