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Gestational diabetes linked with adverse perinatal outcomes

Gestational diabetes linked with adverse perinatal outcomes

Publication date: Friday, 19 May 2017
Contributor(s): Jeremy Bray

New research from a large national database shows an increased risk of adverse outcomes in babies born to mothers with gestational diabetes when compared with non-diabetic mothers.

The database of all 797,346 deliveries in France in 2012 included 57,629 (7.24%) mothers with gestational diabetes. Data linking the mother and the child’s outcomes were available for 88% of the total.

There was an increased risk of a number of complications for mothers with gestational diabetes compared with non-diabetic mothers (Table). Most of this risk was associated with mothers with more serious diabetes who were treated with insulin rather than solely with diet.

After limiting the analysis to normal-term deliveries (37 weeks), an increased risk of death of the newborn baby was observed in women with gestational diabetes. After excluding women suspected to have undiagnosed type 2 diabetes before pregnancy, the risk remained moderately increased only for those women with diet-treated gestational diabetes, with a 30% increased risk of the baby dying. The authors suggest that this difference in risk of death could be because these women tend to give birth later than those who are insulin-treated, meaning the unborn child is exposed to higher glucose levels for longer.

The risk of cardiac malformations is increased for women with insulin-treated gestational diabetes, whereas the risk of nervous system malformations is not. The authors suggested that this could be because early exposure of the embryo to abnormally high glucose levels has different effects on cardiac and nervous system tissues.

Complications

Increased risk

Pre-term birth

30%

Caesarean section

40%

Pre-eclampsia/eclampsia

70%

Macrosomia (baby larger than average)

80%

Respiratory distress

10%

Birth trauma

30%

Cardiac malformations

30%

Table: The increased risk of complications associated with gestational diabetes.

ACTION
The study highlights the higher risks for adverse pregnancy outcomes associated with gestational diabetes and that most of the risks are higher in those women with diabetes requiring treatment with insulin. Although the overall risk of complications during pregnancy is fairly low for these women, this needs to be further reduced.

Billionnet C, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017;60(4):636-44.
link.springer.com/article/10.1007/s00125-017-4206-6

Topics covered:
Category: Evidence in Practice
Edition: Volume 2 Number 4 PCCJ Online 2017
Contributor(s): Jeremy Bray

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