ATLANTIC DIP: Despite insulin therapy in women with IADPSG diagnosed GDM, desired pregnancy outcomes are still not achieved. What are we missing?. (February 2018)

• Record Type: Journal Article
• Authors: Bogdanet, Delia; Egan, Aoife; Reddin, Catriona; Kirwan, Breda; Carmody, Louise; Dunne, Fidelma
• Is Part Of: Diabetes research and clinical practice. Volume 136(2018)
• Page Start: 116
• Page End: 123
• Publication Date: 2018-02
• Subjects: Insulin -- Medical nutritional therapy, gestational diabetes -- IADPSG -- Weight gain -- Pregnancy outcomes; American Diabetes Association ADA -- ante-partum haemorrhage APH -- appropriate weight gain AWG -- ATLANTIC Diabetes in Pregnancy Group ATLANTIC DIP -- caesarean delivery CS -- diastolic blood pressure DBP -- elective caesarean delivery ELCS -- emergency caesarean section EMCS -- gestational diabetes GDM -- gestational weight gain GWG -- hyperglycemia and adverse pregnancy outcome HAPO -- Institute of Medicine IOM -- International Association of the Diabetes in Pregnancy Study Group IADPSG -- large for gestational age LGA -- maturity onset diabetes of the young MODY -- medical nutritional therapy MNT -- neonatal intensive care unit NICU -- oral glucose tolerance test OGTT -- post-partum haemorrhage PPH -- pre-eclampsia PET -- pregnancy induced hypertension PIH -- small for gestational age SGA -- systolic blood pressure SBP -- type 2 diabetes T2DM -- women with gestational diabetes treated with insulin GDM-I -- women with gestational diabetes treated with medical nutritional therapy GDM-M -- World Health Organisation WHO; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.12.003
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: To assess if pregnancy outcomes for women with GDM treated with insulin (GDM-I) are comparable to outcomes for women with GDM treated with medical nutritional therapy (MNT) (GDM-M). Materials and methods: This retrospective cohort study included 752 women with GDM-I and 567 women with GDM-M. Maternal and foetal outcomes were examined. Results: Women with GDM-I had a greater risk of polyhydramnios (aOR 2.33, 95%CI 1.31–4.14) and were more likely to deliver by caesarean section (CS) (aOR 1.67, 95%CI 1.25–2.23). Their offspring had higher rates of macrosomia (22.2% vs 12.7%; p < .01), large for gestational age (LGA) (19.7% vs 12.5%; p < .01) and were more likely to require neonatal intensive care unit (NICU) admission (aOR 4.88, 95%CI 3.54–6.73). There was no difference between the groups in rates of pre-eclampsia (PET), pregnancy-induced hypertension (PIH), infant mortality, congenital malformations, neonatal hypoglycaemia, prematurity and rates of small for gestational age (SGA). Conclusions: GDM-I and GDM-M mothers have similar rates of maternal medical morbidities. Despite this, the rate of delivery by CS remains greater, possibly driven by physician choice for elective intervention in the GDM-I group. Despite insulin therapy, offspring of GDM-I mothers experience higher rates of macrosomia, LGA and NICU admissions. This may be related to the higher baseline risk profile in GDM-I women, to sub-optimal glycaemic control, excessive gestational weight gain (GWG) or higher baseline BMI of the mother. Addressing baseline maternal BMI, limiting excessive GWG and tightening glycaemic control in GDM-I women may translate to better pregnancy outcomes.