Early-Onset of Gestational Diabetes vs. Late-Onset: Can We Revamp Pregnancy Outcomes?
,
Abstract
Background: We assessed risk factors, antenatal and intrapartum complications associated with early-onset Gestational diabetes mellitus (GDM) in comparison with late-onset GDM.
Methods: This retrospective study included 161 GDM women having singleton pregnancies, without previous medical disorder and delivered at a tertiary care Hospital in Ha’il City, KSA from Dec 2020 till Jun 2021. Women diagnosed at < 24 weeks of pregnancy were grouped as early-onset GDM (n=71) and those diagnosed at ≥ 24 weeks as late-onset GDM (n=90). Both groups were matched for background variables. Chi-square and binary logistic regression analysis were applied with P-value significance at 0.05.
Results: Past history of GDM, macrosomia and stillbirth were significant predictors for early-onset GDM (P value 0.000, 0.002 and 0.040 respectively). Regression analysis showed early-onset GDM significantly increases the risk for recurrent urinary tract infections (AOR 2.35), polyhydramnios (AOR 2.81), reduced fetal movements (AOR 2.13), intrauterine fetal demise (AOR 8.06), macrosomia (AOR 2.16), fetal birth trauma (2.58), low APGAR score at birth (AOR 8.06), and neonatal ICU admissions (AOR 2.65). Rate of preterm birth, hypertensive disorders, labor onset (natural vs. induced) and cesarean section and intrapartum maternal complications were same in both groups.
Conclusion: Early-onset GDM significantly increases certain maternal (recurrent urinary tract infections, polyhydramnios and reduced fetal movements) and fetal complications (intrauterine fetal demise, macrosomia fetal birth trauma, low APGAR score at birth and neonatal ICU admissions). Most of these adverse pregnancy outcomes can be prevented through early registration and screening, close follow up, growth ultrasounds, and provision of efficient emergency and neonatal care services.
2. Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F (2019). The impact of diagnostic criteria for ges-tational diabetes on its prevalence: a sys-tematic review and meta-analysis. Diabetol Metab Syndr,11(1):11. doi:10.1186/s13098-019-0406-1.
3. Nguyen CL, Pham NM, Binns CW, Duong D Van, Lee AH (2018). Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Re-view and Meta-Analysis. J Diabetes Res, 2018:6536974. doi:10.1155/2018/6536974
4. Wahabi H, Fayed A, Esmaeil S, Mamdouh H, Kotb R (2017). Prevalence and Com-plications of Pregestational and Gesta-tional Diabetes in Saudi Women: Analysis from Riyadh Mother and Baby Cohort Study (RAHMA). Biomed Res Int, 6878263. doi:10.1155/2017/6878263.
5. Cypryk K, Szymczak W, Czupryniak L, Sob-czak M, Lewiński A (2008). Gestational diabetes mellitus - an analysis of risk fac-tors. Endokrynol Pol, 59(5):393–7.
6. Kc K, Shakya S, Zhang H (2015). Gestation-al diabetes mellitus and macrosomia: a lit-erature review. Ann Nutr Metab, 66 Suppl 2:14-20. doi: 10.1159/000371628.
7. Ornoy A (2011). Prenatal origin of obesity and their complications: Gestational dia-betes, maternal overweight and the para-doxical effects of fetal growth restriction and macrosomia. Reprod Toxicol,32(2):205-212.
8. Shou C, Wei Y-M, Wang C, Yang H-X (2019). Updates in Long-term Maternal and Fetal Adverse Effects of Gestational Diabetes Mellitus. Matern Med,1(2):91-94.
9. Bener A, Saleh NM, Al-Hamaq A (2011). Prevalence of gestational diabetes and as-sociated maternal and neonatal complica-tions in a fast-developing community: global comparisons. Int J Womens Health, 3:367-373.
10. Mohammed AE, Naguib OE, Hamza BT, et al (2015). Gestational diabetes among Saudi women: prevalence, risk factors and pregnancy outcomes. Ann Saudi Med, 35(3):222-230.
11. Abualhamael S, Mosli H, Baig M, Noor AM, Alshehri FM (2019). Prevalence and As-sociated Risk Factors of Gestational Dia-betes Mellitus at a University Hospital in Saudi Arabia. Pakistan J Med Sci, 35(2):325-329.
12. Alsaedi SA, Altalhi AA, Nabrawi MF, Al-dainy AA, Wali RM (2020). Prevalence and risk factors of gestational diabetes mellitus among pregnant patients visiting National Guard primary health care cen-ters in Saudi Arabia. Saudi Med J, 41(2):144-150.
13. Al-Ajlan A, Al-Musharaf S, Fouda MA, et al (2018). Lower vitamin D levels in Saudi pregnant women are associated with higher risk of developing GDM. BMC Pregnancy Childbirth,18(1):86.
14. Al Rowaily MA, Abolfotouh MA (2010). Predictors of gestational diabetes mellitus in a highparity community in Saudi Ara-bia. East Mediterr Health J, 16 (6), 636-641.
15. Alharthi AS, Althobaiti KA, Alswat KA (2018). Gestational Diabetes Mellitus Knowledge Assessment among Saudi Women. Open access Maced J Med Sci, 6(8):1522-1526.
16. Wahabi HA, Fayed AA, Alzeidan RA, Man-dil AA (2014). The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr Disord, 14(1):47.
17. Wahabi HA, Esmaeil SA, Fayed A, Alzeidan RA (2013). Gestational diabetes mellitus: maternal and perinatal outcomes in King Khalid University Hospital, Saudi Arabia. J Egypt Public Health Assoc, 88(2).104-08.
18. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Preg-nancy 2013. WHO/NMH/MND/13.2. Available online at https://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_13.2_eng.pdf;jsessionid=F503D782279A637B1B1D7AC70CC88404?sequence=1 (Ac-cessed on 4 October 2021)
19. Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline (NG3) Published: 25 February 2015 Last updated: 16 Decem-ber 2020 https://www.nice.org.uk/guidance/ng3/chapter/Recommendations#gestational-diabetes
20. Obesity: identification, assessment and management. 2021; (November 2014). Available at: http://www.nice.org.uk/cg189
21. Bashir M, Baagar K, Naem E, et al (2019). Pregnancy outcomes of early detected gestational diabetes: a retrospective com-parison cohort study, Qatar. BMJ Open, e023612. doi:10.1136/ bmjopen-2018-023612
22. Usami T, Yokoyama M, Ueno M, et al (2020). Comparison of pregnancy out-comes between women with early-onset and late-onset gestational diabetes in a retrospective multi-institutional study in Japan. J Diabetes Investig, 11(1):216–22.
23. Boriboonhirunsarn D, Sunsaneevithayakul P, Pannin C, Wamuk T (2021). Prevalence of early-onset GDM and associated risk factors in a university hospital in Thai-land. J Obstet Gynaecol J Inst Obstet Gynae-col, 41(6):915–9.
24. Egan AM, Enninga EAL, Alrahmani L, Weaver AL, Sarras MP, Ruano R (2021). Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience. J Clin Med, 10(4):569.
25. Hosseini E, Janghorbani M, Shahshahan Z (2018). Comparison of risk factors and pregnancy outcomes of gestational diabe-tes mellitus diagnosed during early and late pregnancy. Midwifery, 66:64-69.
26. Shahbazian H, Nouhjah S, Shahbazian N, et al (2016). Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: incidence, contributing factors and outcomes. Diabetes Metab Syndr Clin Res Rev,10(4):242–6.
27. Lee KW, Ching SM, Ramachandran V, Yee A, et al (2018). Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirt,18(1):1–20.
28. Al-Bash MR, Mathew M, Al-Kharusi LA, Abu-Heija AT (2016). Symptomatic uri-nary tract infection in diabetic pregnant women, effect of the type of diabetes and glycemic control. Saudi J Med Med Sci, 4(2):104-7.
29. Bakhsh H, Alenizy H, Alenazi S, et al (2021). Amniotic fluid disorders and the effects on prenatal outcome: A retrospective co-hort study. BMC Pregnancy Child-birth,21(1):1–7.
30. Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R (2003). Early diagnosis of ges-tational diabetes mellitus and prevention of diabetes-related complications. Eur J Obstet Gynecol Reprod Biol,109(1):41–4.
31. Yang Y, Wang Z, Mo M, et al (2018). The association of gestational diabetes melli-tus with fetal birth weight. J Diabetes Com-plications, 32(7):635-642.
32. Muche AA, Olayemi OO, Gete YK (2020). Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth,20(1):1–13.
33. Weschenfelder F, Hein F, Lehmann T, Schleußner E, Groten T (2021). Contrib-uting Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes—What Matters Most? A Retrospective Analysis. J Clin Med,10(2):348.
| Files | ||
| Issue | Vol 51 No 5 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i5.9418 | |
| Keywords | ||
| Gestational diabetes Maternal outcome Fetal outcome | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
