Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar

Mohammed Bashir, Khaled Baagar, Emad Naem, Fadi Elkhatib, Noor Alshaybani, Justin C Konje, Abdul-Badi Abou-Samra, Mohammed Bashir, Khaled Baagar, Emad Naem, Fadi Elkhatib, Noor Alshaybani, Justin C Konje, Abdul-Badi Abou-Samra

Abstract

Objective: To compare pregnancy outcomes in patients with early versus usual gestational diabetes mellitus (GDM).

Design: A retrospective cohort study.

Settings: The Women's Hospital, Hamad Medical Corporation, Qatar.

Participants: GDM women who attended and delivered in the Women's Hospital, between January and December 2016. GDM was diagnosed based on the 2013-WHO criteria. The study included 801 patients; of which, 273 E-GDM and 528 U-GDM. Early GDM (E-GDM) and usual GDM (U-GDM) were defined as GDM detected before and after 24 weeks' gestation, respectively.

Outcomes: Maternal and neonatal outcomes and the impact of timing of GDM-diagnosis on pregnancy outcomes.

Results: At conception, E-GDM women were older (mean age 33.5±5.4 vs 32.0±5.4 years, p<0.001) and had higher body mass index (33.0±6.3 vs 31.7±6.1 kg/m2, p=0.0059) compared with U-GDM. The mean fasting, and 1-hour blood glucose levels were significantly higher in E-GDM vs U-GDM, respectively (5.3±0.7 vs 4.0±0.7 mmol/L, p<0.001 and 10.6±1.7 vs 10.3±1.6 mmol/L, p<0.001). More patients in the U-GDM were managed on diet alone compared with E-GDM (53.6% vs 27.5%, p<0.001). E-GDM subjects gained less weight per week compared with U-GDM (0.02±0.03 vs 0.12±0.03 kg/week, p=0.0274). Maternal outcomes were similar between the two groups apart from a higher incidence of preterm labour (25.5% vs 14.4%; p<0.001) and caesarean section (52.4% vs 42.8%; p=0.01) in E-GDM vs U-GDM, respectively. After correction for covariates; gestational age at which GDM was diagnosed was associated with increased risk of macrosomia (OR 1.06, 95% CI 1.00 to 1.11; p<0.05) and neonatal hypoglycaemia (OR 1.05, 95% CI 1.00 to 1.11; p<0.05).

Conclusion: Our data support the concept of early screening and treatment of GDM in high-risk patients. More data are needed to examine the optimal time for screening.

Keywords: early gestational diabetes; gestational diabetes; gestational weight gain; metformin; obesity.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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