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Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Published:February 07, 2018DOI:https://doi.org/10.1016/j.diabres.2018.02.004

      Highlight

      • Women diagnosed with gestational diabetes mellitus before 24 weeks are at increased risk for adverse outcomes, specifically macrosomia.
      • We suggest caution with use of glyburide in women with an early diagnosis of GDM until further studies regarding glyburide use prior to 24 weeks are available.
      • There is a paucity of data regarding optimal glycemic targets for high-risk women with diabetes in pregnancy, and it is possible that different glycemic targets or alternate therapeutic approaches are needed in this population.
      • Further studies are also needed to establish the risks and benefits of early diabetes screening and treatment.

      Abstract

      Aim

      To examine pregnancy outcomes in women with gestational diabetes mellitus (GDM) based on the timing of diagnosis.

      Method

      We compared demographics, blood sugars and outcomes between women diagnosed before (n = 167) or after 24 weeks’ gestation (n = 1202) in a single hospital between 2009 and 2012. Because early screening is risk-based we used propensity score modelling and conditional logistic regression to account for systematic differences.

      Results

      Women diagnosed with GDM before 24 weeks were more likely to be obese and they were less likely to have excess gestational weight gain (35 vs. 45%, p = 0.04). Early diagnosis was associated with more frequent therapy including glyburide (65 vs. 56%, p < 0.001) and insulin (19 vs 6%, p < 0.001). After propensity score modelling and accounting for covariates, early diagnosis was associated with an increased risk for macrosomia (OR 2, 95% 1–4.15, p = 0.0498). Early diagnosis was not associated with other adverse outcomes. In a subgroup analysis comparing women treated with glyburide prior to 24 weeks compared to those diagnosed after 24 weeks, early diagnosis in women treated with glyburide was associated with an increased risk for macrosomia (OR 2.3, 95% CI 1.1–5.4, P = 0.04).

      Conclusion

      Women diagnosed with GDM before 24 weeks have unique features, are at risk for adverse outcomes, and require targeted approaches to therapy.

      Keywords

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