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Diabetes Res Clin Pract. 2019 Nov;157:107876. doi: 10.1016/j.diabres.2019.107876. Epub 2019 Oct 3.

Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study.

Author information

1
Menzies School of Health Research, NT, Australia; Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia; Danila Dilba Health Service, Darwin, NT, Australia. Electronic address: evelyne.cheng@nt.gov.au.
2
Menzies School of Health Research, NT, Australia. Electronic address: danielle.longmore@menzies.edu.au.
3
Menzies School of Health Research, NT, Australia. Electronic address: federica.barzi@menzies.edu.au.
4
Menzies School of Health Research, NT, Australia; Baker Heart and Diabetes Institute, VIC, Australia. Electronic address: elizabeth.barr@menzies.edu.au.
5
Menzies School of Health Research, NT, Australia. Electronic address: i-lynn.lee@menzies.edu.au.
6
Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia. Electronic address: cherie.whitbread@nt.gov.au.
7
Menzies School of Health Research, NT, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia. Electronic address: jacqueline.boyle@monash.edu.
8
Melbourne School of Population and Global Health, University of Melbourne, Australia. Electronic address: joats@unimelb.edu.au.
9
Primary Health Care Branch, Top End Health Service, NT, Australia. Electronic address: christine.connors@nt.gov.au.
10
Mater Medical Research Institute, University of Queensland, Australia. Electronic address: david.mcintyre@mater.org.au.
11
Menzies School of Health Research, NT, Australia. Electronic address: marie.kirkwood@menzies.edu.au.
12
Menzies School of Health Research, NT, Australia. Electronic address: karen.dempsey@menzies.edu.au.
13
Innovation and Research, Department of Health, NT, Australia. Electronic address: xiaohua.zhang@nt.gov.au.
14
Division of Obstetrics and Gynaecology, Royal Darwin Hospital, NT, Australia. Electronic address: sujatha.thomas@nt.gov.au.
15
Darwin Midwifery Group, NT Health, Australia. Electronic address: desley.williams@nt.gov.au.
16
Department of Diabetes, Central Clinical School, Monash University, Australia. Electronic address: paul.zimmet@monash.edu.
17
South Australian Health and Medical Research Institute, Australia; Faculty of Health and Medical Science, University of Adelaide, Australia. Electronic address: alex.brown@sahmri.com.
18
Baker Heart and Diabetes Institute, VIC, Australia. Electronic address: jonathan.shaw@baker.edu.au.
19
Menzies School of Health Research, NT, Australia; Division of Medicine, Royal Darwin Hospital, NT, Australia. Electronic address: louise.maple-brown@menzies.edu.au.

Abstract

AIMS:

To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy.

METHODS:

Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia.

RESULTS:

Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia.

CONCLUSION:

Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.

KEYWORDS:

Aboriginal and Torres Strait Islander; Gestational diabetes mellitus; Hyperglycaemia in pregnancy; Induction of labour; Lifestyle modification

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