Advertisement
Research Article| Volume 157, 107876, November 2019

Download started.

Ok

Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study

Published:October 03, 2019DOI:https://doi.org/10.1016/j.diabres.2019.107876
Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study
Previous ArticleAssociation between gain in adiposity and diabetic kidney disease worsening in type 2 diabetes is mediated by deteriorating glycaemic control: A 3-year follow-up analysis
Next ArticleUse of a real-time, algorithm-driven, publicly displayed, automated signal to improve insulin prescribing practices

      Abstract

      Aims

      To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy.

      Methods

      Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia.

      Results

      Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia.

      Conclusion

      Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Metzger B.E.
        • Buchanan T.A.
        • Coustan D.R.
        • de Leiva A.
        • Dunger D.B.
        • Hadden D.R.
        • Hod M.
        • Kitzmiller J.L.
        • Kjos S.L.
        • Oats J.N.
        • Pettitt D.J.
        • Sacks D.A.
        • Zoupas C.
        Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus.
        Diabetes Care. 2007; 30: S251-S260https://doi.org/10.2337/dc07-s225
        View in Article
        • Sacks D.A.
        • Hadden D.R.
        • Maresh M.
        • Deerochanawong C.
        • Dyer A.R.
        • Metzger B.E.
        • et al.
        Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria. The hyperglycemia and adverse pregnancy.
        Outcome (HAPO) Study. 2012; 35: 526-528
        View in Article

      3. Li L, O'Neil L. Mothers and Babies 2015: Northern Territory Midwives' Collection. Darwin: Department of Health; 2018. Available from: <https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/6935/1/Mothers%20and%20Babies%202015.pdf>.

        View in Article

      4. Australian Institute of Health and Welfare. Diabetes in pregnancy: its impact on Australian women and their babies. Canberra: Australian Institute of Health and Welfare; 2010. (Diabetes series; No.:14).

        View in Article
        • Casey B.M.
        • Lucas M.J.
        • McIntire D.D.
        • Leveno K.J.
        Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population.
        Obstet Gynecol. 1997; 90: 869-873
        View in Article
        • Metzger B.E.
        • Lowe L.P.
        • Dyer A.R.
        • Trimble E.R.
        • Chaovarindr U.
        • Coustan D.R.
        • et al.
        Hyperglycemia and adverse pregnancy outcomes.
        N Engl J Med. 2008; 358: 1991-2002
        View in Article
        • Dabelea D.
        • Knowler W.C.
        • Pettitt D.J.
        Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians.
        J Matern Fetal Med. 2000; 9: 83-88
        View in Article
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        View in Article
        • Crowther C.A.
        • Hiller J.E.
        • Moss J.R.
        • McPhee A.J.
        • Jeffries W.S.
        • Robinson J.S.
        Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
        N Engl J Med. 2005; 352: 2477-2486
        View in Article
        • Horvath K.
        • Koch K.
        • Jeitler K.
        • Matyas E.
        • Bender R.
        • Bastian H.
        • et al.
        Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis.
        BMJ. 2010; 340c1395
        View in Article
        • Langer O.
        • Yogev Y.
        • Xenakis E.M.
        • Brustman L.
        Overweight and obese in gestational diabetes: the impact on pregnancy outcome.
        Am J Obstet Gynecol. 2005; 192: 1768-1776
        View in Article
        • Vestgaard M.
        • Christensen A.S.
        • Viggers L.
        • Lauszus F.F.
        Birth weight and its relation with medical nutrition therapy in gestational diabetes.
        Arch Gynecol Obstet. 2017; 296: 35-41
        View in Article
        • Kgosidialwa O.
        • Egan A.M.
        • Carmody L.
        • Kirwan B.
        • Gunning P.
        • Dunne F.P.
        Treatment with diet and exercise for women with gestational diabetes mellitus diagnosed using IADPSG criteria.
        J Clin Endocrinol Metab. 2015; 100: 4629-4636
        View in Article

      14. Queensland Clinical Guidelines. Gestational diabetes mellitus [internet]. Queensland: Queensland Health; 2015 August [cited 2019 June 20]. 38p. Guideline No. MN15.33-V1-R20. Available from <https://www.health.qld.gov.au/qcg>.

        View in Article

      15. SA Maternal & Neonatal Clinical Network. South Australia Perinatal Practice Guidelines: Diabetes mellitus and gestational diabetes [internet]. South Australia: Department of Health, Government of South Australia; 2015 June [cited 2019 June 20]. 18p. Available from <https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/perinatal/perinatal+practice+guidelines#D>.

        View in Article
        • Maple-Brown L.J.
        • Brown A.
        • Lee I.L.
        • Connors C.
        • Oats J.
        • McIntyre H.D.
        • et al.
        Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study.
        BMC Pregnancy Childbirth. 2013; 13: 221
        View in Article

      17. American College of Obstetricians and Gynaecologists. Committee Opinion No. 548: Weight gain during pregnancy. Obstetr Gynaecol 2013;121:210–12.

        View in Article

      18. Nankervis A, McIntyre HD, Moses R, Ross GP, Callaway L, Porter C, et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. Sydney: Australasian Diabetes in Pregnancy Society; November 2014. <https://www.adips.org/downloads/2014ADIPSGDMGuidelinesV18.11.2014_000.pdf> [accessed August 2019].

        View in Article
        • Hoffman L.
        • Nolan C.
        • Wilson J.D.
        • Oats J.J.
        • Simmons D.
        Gestational diabetes mellitus–management guidelines. The Australasian Diabetes in Pregnancy Society.
        Med J Aust. 1998; 169: 93-97
        View in Article

      20. World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. WHO/NMH/MND/13.2 ed. Geneva: World Health Organization; 2013.

        View in Article
        • Dobbins T.A.
        • Sullivan E.A.
        • Roberts C.L.
        • Simpson J.M.
        Australian national birthweight percentiles by sex and gestational age, 1998–2007.
        Med J Aust. 2012; 97: 291
        View in Article
        • Guaran R.L.
        • Wein P.
        • Sheedy M.
        • Walstab J.
        • Beischer N.A.
        Update of growth percentiles for infants born in an Australian population.
        Aust N Z J Obstet Gynaecol. 1994; 34: 39-50
        View in Article
        • Maple-Brown L.
        • Lee I.L.
        • Longmore D.
        • Barzi F.
        • Connors C.
        • Boyle J.A.
        • et al.
        Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort.
        Int J Epidemiol. 2019; 48: 307-318
        View in Article
        • Lee I.
        • Purbrick B.
        • Barzi F.
        • Brown A.
        • Connors C.
        • Whitbred C.
        • et al.
        Cohort profile: the pregnancy and neonatal diabetes outcomes in remote Australia (PANDORA) Study.
        Int J Epidemio. 2018; 47: 1045-1046
        View in Article
        • Brody S.C.
        • Harris R.
        • Lohr K.
        Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force.
        Obstet Gynecol. 2003; 101: 380-392
        View in Article
        • Coustan D.R.
        Management of gestational diabetes mellitus: a self-fulfilling prophecy?.
        JAMA. 1996; 275: 1199-1200
        View in Article
        • Naylor C.D.
        • Sermer M.
        • Chen E.
        • Sykora K.
        Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators.
        Jama. 1996; 275: 1165-1170
        View in Article
        • Hutcheon J.A.
        • Zhang X.
        • Platt R.W.
        • Cnattingius S.
        • Kramer M.S.
        The case against customised birthweight standards.
        Paediatr Perinat Epidemiol. 2011; 25: 11-16
        View in Article
        • Pain S.
        • Chang A.M.
        • Flenady V.
        • Chan F.Y.
        Customised birth weight: coefficients for an Australian popultion and valudation of the model.
        ANZJOG. 2006; 46: 388-1294
        View in Article
        • Abell S.K.
        • Teede H.J.
        The IADPSG diagnostic criteria identify women with increased risk of adverse pregnancy outcomes in Victoria.
        ANZJOG. 2017; 57: 564-568
        View in Article
        • Cheung N.W.
        • Jiang S.
        • Athayde N.
        Impact of the IADPSG criteria for gestational diabetes, and of obesity, on pregnancy outcomes.
        ANZJOG. 2018; 58: 553-559
        View in Article
        • American Diabetes Association
        Position statement: nutrition recommendations and interventions for diabetes.
        Diabetes Care. 2008; 31: S61-S78
        View in Article
        • Irala-Estevez J.D.
        • Groth M.
        • Johansson L.
        • Oltersdorf U.
        • Prattala R.
        • Martinez-Gonzalez M.A.
        A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables.
        Eur J Clin Nutr. 2000; 54: 706-714
        View in Article
        • Brimblecombe J.K.
        • O'Dea K.
        The role of energy cost in food choices for an Aboriginal population in northern Australia.
        Med J Aust. 2009; 190: 549-551
        View in Article

      Article info

      Publication history

      Published online: October 03, 2019
      Accepted: October 2, 2019
      Received in revised form: September 8, 2019
      Received: July 5, 2019

      Identification

      DOI: https://doi.org/10.1016/j.diabres.2019.107876

      Copyright

      © 2019 Elsevier B.V. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX