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Diabetes Care. 2016 Jan;39(1):75-81. doi: 10.2337/dc15-0433. Epub 2015 Dec 8.

Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment.

Author information

1
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia aswe6150@uni.sydney.edu.au.
2
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
3
Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia.
4
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Abstract

OBJECTIVE:

Recent guidelines recommend testing at <24 weeks of gestation for maternal dysglycemia in "high-risk" women. Evidence to support the early identification and treatment of gestational diabetes mellitus (GDM) is, however, limited. We examined the prevalence, clinical characteristics, and pregnancy outcomes of high-risk women with GDM diagnosed at <24 weeks of gestation (early GDM) and those with pre-existing diabetes compared with GDM diagnosed at ≥24 weeks of gestation, in a large treated multiethnic cohort.

RESEARCH DESIGN AND METHODS:

Outcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at <12 weeks of gestation (n = 68), at 12-23 weeks of gestation (n = 1,247), or at ≥24 weeks of gestation (n = 3,493).

RESULTS:

Hypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at <12 weeks of gestation were comparable to rates seen in women with pre-existing diabetes.

CONCLUSIONS:

Despite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.

PMID:
26645084
DOI:
10.2337/dc15-0433
[Indexed for MEDLINE]

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