TY - JOUR
T1 - Impact of previous gestational diabetes management on perinatal outcomes in subsequent pregnancies affected by gestational diabetes mellitus
AU - Klein, Dahlia
AU - Berezowsky, Alexandra
AU - Melamed, Nir
AU - Barret, Jon
AU - Ray, Joel
AU - Persaud, Mira
AU - Murray-Davis, Beth
AU - McDonald, Sarah D.
AU - Geary, Michael P.
AU - Berger, Howard
AU - Ashwal, Eran
N1 - Publisher Copyright:
© 2024 International Federation of Gynecology and Obstetrics.
PY - 2024/12
Y1 - 2024/12
N2 - Objective: To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. Methods: This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012-2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM diagnosis, categorized into medical and dietary management. The primary outcome was a composite including need for pharmacotherapy, large-for-gestational age, or neonatal hypoglycemia. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression controlling for maternal age, pre-pregnancy body mass index, and gestational age at GDM diagnosis in the index pregnancy. Results: Of the 544 patients, 164 (30.1%) had prior GDM. Prior GDM significantly increased the likelihood of composite outcome compared to no prior GDM (74.4% vs. 57.4%; P < 0.001). After adjusting for confounders, prior GDM remained significantly associated with the composite outcome (aOR 2.03, 95% confidence interval [CI] 1.31–3.15). Stratifying by prior GDM treatment modality, a significant association was found for prior pharmacotherapy-controlled GDM (aOR 3.29, 95% CI 1.64–6.59), but not for prior diet-controlled GDM (aOR = 1.54, 95% CI 0.92–2.60). Conclusion: A history of pharmacotherapy-controlled GDM in a previous pregnancy increases odds of adverse perinatal outcomes in a subsequent GDM pregnancy.
AB - Objective: To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. Methods: This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012-2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM diagnosis, categorized into medical and dietary management. The primary outcome was a composite including need for pharmacotherapy, large-for-gestational age, or neonatal hypoglycemia. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression controlling for maternal age, pre-pregnancy body mass index, and gestational age at GDM diagnosis in the index pregnancy. Results: Of the 544 patients, 164 (30.1%) had prior GDM. Prior GDM significantly increased the likelihood of composite outcome compared to no prior GDM (74.4% vs. 57.4%; P < 0.001). After adjusting for confounders, prior GDM remained significantly associated with the composite outcome (aOR 2.03, 95% confidence interval [CI] 1.31–3.15). Stratifying by prior GDM treatment modality, a significant association was found for prior pharmacotherapy-controlled GDM (aOR 3.29, 95% CI 1.64–6.59), but not for prior diet-controlled GDM (aOR = 1.54, 95% CI 0.92–2.60). Conclusion: A history of pharmacotherapy-controlled GDM in a previous pregnancy increases odds of adverse perinatal outcomes in a subsequent GDM pregnancy.
KW - gestational diabetes mellitus
KW - glycemic control
KW - large for gestational age
KW - pharmacotherapy
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85197710180&partnerID=8YFLogxK
U2 - 10.1002/ijgo.15775
DO - 10.1002/ijgo.15775
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C2 - 38972010
AN - SCOPUS:85197710180
SN - 0020-7292
VL - 167
SP - 1131
EP - 1137
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -