Impact of previous gestational diabetes management on perinatal outcomes in subsequent pregnancies affected by gestational diabetes mellitus

Dahlia Klein*, Alexandra Berezowsky, Nir Melamed, Jon Barret, Joel Ray, Mira Persaud, Beth Murray-Davis, Sarah D. McDonald, Michael P. Geary, Howard Berger, Eran Ashwal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1131-1137
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Volume167
Issue number3
DOIs
StatePublished - Dec 2024
Externally publishedYes

Funding

FundersFunder number
Canada Research Chairs

    Keywords

    • gestational diabetes mellitus
    • glycemic control
    • large for gestational age
    • pharmacotherapy
    • pregnancy

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