Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

A comparison of pregnancy outcomes in treated GDM women compared to those without GDM (#183)

Tang Wong 1 2 3 , Glynis P Ross 1 2 , N Wah Cheung 2 4 , Robyn A Barnes 1 5 , Jeff R Flack 1 3 6
  1. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  2. University of Sydney, Sydney, Australia
  3. University of NSW, Sydney, Australia
  4. Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW, Australia
  5. University of Newcastle, Newcastle, NSW, Australia
  6. Western Sydney Univerisity, Sydney, NSW, Australia

Background: The Hyperglycemia and Adverse Pregnancy Outcomes study (HAPO) demonstrated continuous relationships between maternal glycaemia and adverse outcomes[1]. Randomised controlled studies have demonstrated that treatment of gestational diabetes (GDM) reduces this risk.

Aim: To compare outcomes of pregnant women treated for GDM with those of normal glucose tolerant (NGT) women.

Methods:

We reviewed data from the Bankstown-Lidcombe Hospital diabetes, perinatal and pathology databases between 2011-2015. Women were classified as having GDM or normal glucose tolerance (NGT) according to ADIPS 1998 criteria[2].

Women diagnosed with GDM were educated on blood glucose monitoring, medical nutrition therapy and exercise. Insulin was commenced if glycaemic targets were not met. Metformin was not used.

Antenatal maternal characteristics and perinatal outcomes, including gestational weight gain (GWG), incidence of pre-eclampsia, prematurity (<37 weeks), induction of labour, caesarean section, low birth weight(LBW<2500g ) and macrosomia(>4000g), Apgars and neonatal ICU(NICU) admission were compared between GDM and NGT women. GWG was calculated as self reported pre-pregnancy weight subtracted from last maternal weight measured after 36 weeks gestation.  Independent sample t-tests and chi-square analyses were used to assess for statistical significance.

Results

There were 1503 GDM women and 9454 NGT women. At baseline, GDM women were older, had higher pre-pregnancy BMI, increased incidence of chronic hypertension, greater number of prior pregnancies >20 weeks, higher fasting and 2 hour glucose levels on oGTT. There was a greater proportion of non-caucasian ethnicities amongst GDM women.

Treatment of women with GDM reduced GWG and mean birthweight. There was a similar risk of low birthweight and macrosomia.  Outcomes of women with GDM compared to those with NGT are summarised in table 1.

591d3e7a84ef5-Outcomes1.jpg

Conclusion

Treatment of GDM was effective in reducing rates of pre-eclampsia, macrosomia and low birthweight to the background rates observed in women with NGT, but obstetric intervention was more common.

  1. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 2008. 358(19): p. 1991-2002.
  2. Hoffman, L., et al., Gestational diabetes mellitus-management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust, 1998. 169(2): p. 93-7.