Gestational, Pregestational Diabetes Increased Risk for Adverse Neonatal Outcomes

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Gestational and pregestational diabetes were associated with adverse neonatal outcomes.
Gestational and pregestational diabetes were associated with adverse neonatal outcomes.

Pregnant women with gestational diabetes and pregestational diabetes were at increased risk for delivering babies with neonatal hypoglycemia, fetal malformations, and other adverse neonatal outcomes.

The results were presented at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting.

In the study, Basilio Pintaudi, MD, investigator with the Niguarda Cà Granda Hospital, Milan, Italy, and colleagues aimed to better understand the risks of adverse neonatal outcomes in pregnancies complicated by gestational diabetes and pregestational diabetes.

“The independent role [of gestational diabetes and pregestational diabetes] in conferring higher risks of adverse pregnancy outcomes compared with normal pregnancy has not been completely or in a systematic way studied,” Dr Pintaudi said in an interview. “The main reason for this is that several significant medical conditions capable of impairing pregnancy outcomes were not simultaneously taken into account in most of the performed studies on the topic. This is why we investigated also hypertensive and thyroid disorders (2 of the most frequent clinical diseases complicating the pregnancy) and drug use in pregnancy (as a proxy of pregnancy complexity).”

In all, researchers assessed administrative data of the Italian Puglia region from 2002 until 2012, which totaled nearly 2.1 million women. The final analysis included 133 572 normal pregnancies, 1357 pregnancies complicated by gestational diabetes and 234 pregnancies complicated by pregestational diabetes.

Compared with normal pregnancies, both gestational diabetes and pregestational diabetes increased the risk for the following adverse events:

  • Neonatal hypoglycemia (gestational diabetes, odds ratio [OR]=10.1; pregestational diabetes, OR=36)
  • Small for gestational age (gestational diabetes, OR=1.7; pregestational diabetes, OR=5.8)
  • Large for gestational age (gestational diabetes, OR=1.7; pregestational diabetes, OR=7.9)
  • Jaundice (gestational diabetes, OR=1.7; pregestational diabetes, OR=2.6)
  • Fetal malformations (gestational diabetes, OR=2.2; pregestational diabetes, OR=3.5)
  • Low levels of calcium and magnesium (gestational diabetes, OR=1.8; pregestational diabetes, OR=9.2)

Furthermore, in the pregestational diabetes group, respiratory distress (OR=2.7) and excess amniotic fluid (OR=46.5) were also increased, whereas there were no significant increases in the gestational diabetes group.

“The finding of a high risk for electrolytes disorders (hypocalcemia and hypomagnesemia) is clinically important because this outcome is not typically explored,” Dr Pintaudi said, adding that the observed associations with respiratory distress and alteration of the amniotic fluid could drive clinicians involved in the care of pregnancy to prevent or delay, if possible, these specific conditions.

Dr Pintaudi concluded that these results should raise the awareness of health care professionals and policy makers on this important health care matter. “An early referral to specialists involved in the care of medical conditions complicating the pregnancy course should be planned by the gynecologist,” he said. “Greater efforts in facilitating clinical collaboration between health care professionals and in promoting research projects are desirable.”

Disclosures: The researchers report no relevant financial disclosures.

For more coverage of EASD 2016, click here.

Reference

  1. Pintaudi B, Lucisano G, Di Vieste G, D'Ettorre A, Nicolucci A. Poster 924. Glucose alteration in pregnancy and risk of adverse neonatal outcomes. Presented at: EASD 2016 Annual Meeting; September 12-16, 2016; Munich, Germany.
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