Neonatal and obstetric outcomes in diet- and insulin-treated women with gestational diabetes mellitus: a retrospective study

Sarah H Koning, Klaas Hoogenberg, Kirsten A Scheuneman, Mick G Baas, Fleurisca J Korteweg, Krystyna M Sollie, Bertine J Schering, Aren J van Loon, Bruce H R Wolffenbuttel, Paul P van den Berg, Helen L Lutgers, Sarah H Koning, Klaas Hoogenberg, Kirsten A Scheuneman, Mick G Baas, Fleurisca J Korteweg, Krystyna M Sollie, Bertine J Schering, Aren J van Loon, Bruce H R Wolffenbuttel, Paul P van den Berg, Helen L Lutgers

Abstract

Background: To evaluate the neonatal and obstetric outcomes of pregnancies complicated by gestational diabetes mellitus (GDM). Screening and treatment - diet-only versus additional insulin therapy - were based on the 2010 national Dutch guidelines.

Methods: Retrospective study of the electronic medical files of 820 singleton GDM pregnancies treated between January 2011 and September 2014 in a university and non-university hospital. Pregnancy outcomes were compared between regular care treatment regimens -diet-only versus additional insulin therapy- and pregnancy outcomes of the Northern region of the Netherlands served as a reference population.

Results: A total of 460 women (56 %) met glycaemic control on diet-only and 360 women (44 %) required additional insulin therapy. Between the groups, there were no differences in perinatal complications (mortality, birth trauma, hyperbilirubinaemia, hypoglycaemia), small for gestational age, large for gestational age (LGA), neonate weighing >4200 g, neonate weighing ≥4500 g, Apgar score <7 at 5 min, respiratory support, preterm delivery, and admission to the neonatology department. Neonates born in the insulin-group had a lower birth weight compared with the diet-group (3364 vs. 3467 g, p = 0.005) and a lower gestational age at birth (p = 0.001). However, birth weight was not different between the groups when expressed in percentiles, adjusted for gestational age, gender, parity, and ethnicity. The occurrence of preeclampsia and gestational hypertension was comparable between the groups. In the insulin-group, labour was more often induced and more planned caesarean sections were performed (p = 0.001). Compared with the general obstetric population, the percentage of LGA neonates was higher in the GDM population (11.0 % vs.19.9 %, p = <0.001).

Conclusions: Neonatal and obstetric outcomes were comparable either with diet-only or additional insulin therapy. However, compared with the general obstetric population, the incidence of LGA neonates was significantly increased in this GDM cohort.

Keywords: Diet; Gestational diabetes mellitus; Insulin; Pregnancy outcomes; Treatment.

Figures

Fig. 1
Fig. 1
Flow-chart of the study design. GDM, Gestational Diabetes Mellitus; NPH, Neutral Protamine Hagedorn; SMBG; Self-Monitoring Blood Glucose

References

    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81. doi: 10.2337/dc14-S081.
    1. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007;34(2):173–99. doi: 10.1016/j.ogc.2007.03.002.
    1. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30(9):2287–92. doi: 10.2337/dc06-2361.
    1. Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care. 1995;18(5):611–7. doi: 10.2337/diacare.18.5.611.
    1. Sermer M, Naylor CD, Gare DJ, Kenshole AB, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes: the Toronto Tri-Hospital Gestational Diabetes Project. Obstet Gynecol. 1995;173(1):146–56.
    1. Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes. Diabetes Care. 2002;25(9):1619–24. doi: 10.2337/diacare.25.9.1619.
    1. Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Obstet Gynecol. 2005;192(4):989–97.
    1. Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339–48. doi: 10.1056/NEJMoa0902430.
    1. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477–86. doi: 10.1056/NEJMoa042973.
    1. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002. doi: 10.1056/NEJMoa0707943.
    1. The Dutch society of Obstetrics and Gynaecology. Diabetes Mellitus and Pregnancy. Clinical guideline version 2.0. 2010; . Accessed 22 Sept 2015. (in Dutch)
    1. World Health Organization . Definition and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva: Department of Noncommunicable Disease Surveillance, World Health Organization; 1999.
    1. National Institute for Health and Clinical Excellence. Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. London: National Colloborating Centre for Women's and Children's Health; 2008.
    1. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the US Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013;159(2):123–9. doi: 10.7326/0003-4819-159-2-201307160-00661.
    1. Falavigna M, Schmidt MI, Trujillo J, Alves LF, Wendland ER, Torloni MR, Colagiuri S, Duncan BB. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes Res Clin Pract. 2012;98(3):396–405. doi: 10.1016/j.diabres.2012.09.002.
    1. Poolsup N, Suksomboon N, Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2014;9(3):e92485. doi: 10.1371/journal.pone.0092485.
    1. Alwan N, Tuffnell DJ, West J. Treatments for gestational diabetes. Cochrane Database Syst Rev. 2009;3:CD003395.
    1. Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;340:c1395. doi: 10.1136/bmj.c1395.
    1. University Medical Center Groningen. Research code University Medical Center Groningen. 2013; . Accessed 16 Mar 2016.
    1. Visser GH, Eilers PH, Elferink-Stinkens PM, Merkus HM, Wit JM. New Dutch reference curves for birthweight by gestational age. Early Hum Dev. 2009;85(12):737–44. doi: 10.1016/j.earlhumdev.2009.09.008.
    1. Lai FY, Johnson JA, Dover D, Kaul P. Outcomes of singleton and twin pregnancies complicated by pre‐existing diabetes and gestational diabetes: a population‐based study in Alberta, Canada, 2005–11. J Diabetes. 2016;8(1):45–55. doi: 10.1111/1753-0407.12255.
    1. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82. doi: 10.2337/dc09-1848.
    1. World Health Organization. Diagnostic criteria and classification of hypoglycemia first detected in pregnancy. 2013; . Accessed 16 Mar 2016.
    1. Benhalima K, Mathieu C, Damm P, et al. A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG) Diabetologia. 2015;58(7):1422–9. doi: 10.1007/s00125-015-3615-7.
    1. National Institute for Health and Care Excellence. Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. Clinical guideline NG3 (2015). 2015; . Accessed 16 Mar 2016.
    1. Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia. 2015;58(9):2003–12. doi: 10.1007/s00125-015-3647-z.
    1. Sweeting AN, Ross GP, Hyett J, et al. Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment. Diabetes Care. 2016;39(1):75–81. doi: 10.2337/dc15-0433.
    1. Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013;36(1):56–62. doi: 10.2337/dc12-0741.
    1. Barnes R, Edghill N, Mackenzie J, et al. Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. Diabet Med. 2013;30(9):1040–6. doi: 10.1111/dme.12207.
    1. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780–6. doi: 10.2337/dc11-1790.
    1. Wahabi HA, Fayed AA, Alzeidan RA, Mandil AA. The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr Disord. 2014;14(1):1. doi: 10.1186/1472-6823-14-47.
    1. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10(1):1. doi: 10.1186/1741-7015-10-47.
    1. Duran A, Saenz S, Torrejon MJ, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St Carlos Gestational Diabetes Study. Diabetes Care. 2014;37(9):2442–50.

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