Prediabetes in pregnancy – follow-up, treatment, and outcomes compared to overt pregestational diabetes

Schiller, Tal; Barak, Oren; Shafran, Yael Winter; Sacagiu, Miri; Cohen, Lee S.; Vaisbuch, Edi; Zornitzki, Taiba; Kirzhner, Alena

doi:10.1080/14767058.2023.2191153

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…It was observed in this study that 52.5% of women with ODM went to a specialized prenatal care center in the third trimester of pregnancy, while those with T2DM went during the first trimester. Late arrival to the specialized prenatal care center has also been reported in the study of Schiller et al [18]. Similarly, in a retrospective observational study from a tertiary care center in Pakistan, 55.3% cases of overt diabetes were diagnosed and followed up late during pregnancy [13].…”

Section: Discussionmentioning

confidence: 58%

“…In particular, Oppermann et al have shown that there are no differences in pregnancy outcomes in the two groups of evaluated pregnant women [17]. Significant differences in macrosomia and neonatal jaundice are reported by Schiller et al: this study compared pregnant women with prediabetes and pregnant women with pregestational overt type 2 diabetes, which included women with known type 2 diabetes or those that are first diagnosed during pregnancy [18]. Thus, we think it is of interest to study the pregnancy outcomes of women affected by overt diabetes and compare them to those of women with known pre-existing type 2 diabetes.…”

Section: Introductionmentioning

confidence: 87%

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A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

Dalfrà,

Burlina,

Fioretti

et al. 2024

Endocrines

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Background: Pregestational diabetes mellitus, if not well controlled, determines maternal and fetal complications. According to the new diagnostic criteria for gestational diabetes, the diagnosis of diabetes mellitus can also occur in early pregnancy (overt diabetes). Aim: This study aims to determine pregnancy outcomes in women with overt diabetes compared to women with pre-existing type 2 diabetes. Methods: In this retrospective study, we selected women with pre-existing type 2 and overt diabetes who had at least one pregnancy in the 2010–2022 period at the Diabetic Care Unit of Padova. Results: We analyzed 83 pregnancies, and overt diabetes was diagnosed in 18 pregnancies. In total, 95.5% of patients with overt diabetes and 48% of T2DM patients were immigrants (p < 0.143). No patients with overt diabetes planned their pregnancy, while pregnancy was planned in 26.3% of patients with pre-exiting type 2 diabetes (p < 0.05). Periconception and first-trimester glycemic control were the worst in patients with overt diabetes (HbA1c 9.7 ± 3.1% vs. 7.3% ± 2.3%, p < 0.044, at first visit; 8.1 ± 1.9% and 7.0 ± 1.6%, p < 0.037 in the first trimester) with respect to patients with pre-existing type 2 diabetes. As for maternal outcomes, 16.6% of pregnancies ended in miscarriage, and 5.5% of women developed gestational hypertension; as for newborn outcomes, 16.6% of newborns were LGA, and 11.1% were affected by congenital anomalies without any significant difference with respect to women with pre-existing type 2 diabetes. The high rate of congenital malformations in pregnancies of women with overt diabetes is probably a result of the poor, metabolic control observed during the periconception period when the organogenesis of the fetus takes place. Conclusions: It is essential to utilize procedures for diabetes screening in women of childbearing age not only at the beginning of the pregnancy, but also during the preconception phase or the postmenarcheal period when strong risk factors for diabetes onset are present, such as a high BMI, glycemic disorders, and those who fall under high-risk ethnicity categories.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 87%

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

Dalfrà,

Burlina,

Fioretti

et al. 2024

Endocrines

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“…This finding can be explained by the worse glycemic control observed in overt type 2 pregnant women and by the fact that none of these women planned their pregnancy. In a case control study that has evaluated 414 T2DM and 2014 OT2DM even if women with OT2 DM arrived to specialized prenatal care center at the third trimester of pregnancy while those with T2DM at the first trimester no differences in maternal and fetal outcomes have been found also considering congenital malformations; it is to notice that mean values of HbA1c at booking were no different and no bad in the two groups ( 7.2 vs 7.4 %),and that 70% of women were white (15).In a retrospective study comparing 120 OT2DM pregnant women and 86 T2DM, 75% of caucasian race, even if 55% of OT2DM women arrived late at the specialized prenatal care center no significant differences have been found in the two groups regarding maternal an fetal outcomes (16). It is to notice however that OT2 DM have significantly lower values of HbA1c compared to T2DM in pre pregnancy and in the first trimester and that no data are reported on congenital malformations.…”

Section: Discussionmentioning

confidence: 91%

Outcomes of Pregnancy Affected by Overt Type 2 Diabetes in a Diabetic Care Unit of Padova

Dalfrà,

Burlina,

Fioretti

et al. 2023

Preprint

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Pregestational diabetes mellitus, if not well controlled, determines maternal and fetal complications. According to the new diagnostic criteria for gestational diabetes the diagnosis of diabetes mellitus can also occur in early pregnancy (overt diabetes ).The aim of this study was to determine pregnancy outcomes in women with overt type 2 diabetes. In this retrospective study we selected women with type 2 diabetes, pregestational or overt diabetes, who had at least one pregnancy followed in the period 2010-2022 at the Diabetic Care Unit of Padova.We analyzed 83 pregnancies in 68 diabetic patients; overt diabetes was diagnosed in 21,7% of pregnancies . 95% of patents with overt diabetes was immigrate . None of patients with overt type 2 diabetes planned their pregnancy, while pregnancy was planned in 26,3% of patients with pregestationalType 2 diabetes. Pre-pregnancy and first trimester glycemic control was worst in patients with overt diabetes(HbA1c 9.7± 3.1% vs 7.3% ± 2.3%, p< 0.044 at first visit; 8.1±1.9%, and 7.0±1.6%, p< 0.037 in the first trimester) with respect to type 2 diabetic mothers.As for maternal outcomes, 16,6% of pregnancy ended in miscariage and 5,5% of women developed gestational hypertension . 16,6% of newborn were LGA and 11,1% were affected by congenital anomalies. The high rate of congenital malformations in overt diabetes pregnancies is probably due to the worse metabolic control during the first trimester of pregnancy, when the organogenesis of the fetus takes place. So it is essential to identify these patients in the preconception phase so they can conceive in good glycemic control.

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Utility of the cerebro‐placental‐uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study

Agaoglu,

Tanacan,

Ipek

et al. 2024

J of Clinical Ultrasound

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PurposeTo examine the cerebro‐placental‐uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes.MethodsThis prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low‐risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated.ResultsCPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut‐off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut‐off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity).ConclusionLow CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.

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Prediabetes in pregnancy – follow-up, treatment, and outcomes compared to overt pregestational diabetes

Cited by 4 publications

References 17 publications

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

Outcomes of Pregnancy Affected by Overt Type 2 Diabetes in a Diabetic Care Unit of Padova

Utility of the cerebro‐placental‐uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study

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