Early Diagnosis of Prediabetes among Pregnant Women that Develop Gestational Diabetes Mellitus and Its Influence on Perinatal Outcomes

Abstract

Objective Purpose of this study was to determine whether early identification of impaired glucose tolerance consistent with prediabetes among pregnant women with gestational diabetes mellitus (GDM) in the first trimester impacts maternal and neonatal outcomes.

Study Design This was a retrospective cohort study of patients who were screened for pregestational diabetes in early pregnancy at a large academic tertiary care center from October 1, 2017, to January 31, 2021, and who subsequently developed GDM. Demographic and perinatal outcomes were compared among women with GDM with a positive early diabetes screen consistent with prediabetes to women who screened negative in the first trimester. Multivariable logistic regression was performed to adjust for baseline demographic differences.

Results During the study period, 260 women screened had negative first trimester diabetes screening and subsequently developed GDM, while 696 screened positive for prediabetes and developed GDM. Women with prediabetes were more likely to require insulin treatment for their GDM compared with those that screened negative (79.5 vs. 45.4%, p < 0.001), while those who screened negative were more likely to take an oral medication of metformin or glyburide for GDM management than those with prediabetes (41.5 vs. 16.4%, p < 0.001). Infants born to mothers who screened positive for prediabetes were more likely to require neonatal intensive care unit (NICU) admission compared with those who screened negative even when adjusted for type of GDM treatment used (adjusted odds ratio [aOR] = 8.5, 95% confidence interval [CI]: 1.5–49.9).

Conclusion Women identified as having early impaired glucose tolerance consistent with prediabetes that subsequently develop GDM are more likely to be prescribed insulin treatment and may be at increased risk of adverse neonatal outcomes leading to NICU admission than women with negative first trimester diabetes screening. Future studies should focus on whether different methods of early treatment and/or intervention improve perinatal outcomes.

Key Points

• Prediabetes in early pregnancy is associated with higher rates of insulin treatment for GDM.

• Prediabetes in pregnancy increases the risk of developing GDM.

• Prediabetes in early pregnancy is associated with higher rates of NICU admission.

Keywords

prediabetes - gestational diabetes - early screening

Publikationsverlauf

Eingereicht: 01. April 2021

Angenommen: 24. Oktober 2021

Accepted Manuscript online:
28. Oktober 2021

Artikel online veröffentlicht:
02. Dezember 2021

• References

• 1 Yogev Y, Xenakis EM, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol 2004; 191 (05) 1655-1660
• 2 Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 2004; 191 (03) 969-974
• 3 Jovanovic-Peterson L, Peterson CM, Reed GF. et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development–Diabetes in Early Pregnancy Study. Am J Obstet Gynecol 1991; 164 (1, pt. 1): 103-111
• 4 Voormolen DN, de Wit L, van Rijn BB. et al. Neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus. Diabetes Care 2018; 41 (07) 1385-1390
• 5 Gestational diabetes mellitus. ACOG practice bulletin no. 190. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 131: e49-e64
• 6 Simmons D, Devers MC, Wolmarans L, Johnson E. Difficulties in the use of risk factors to screen for gestational diabetes mellitus. Diabetes Care 2009; 32 (01) e8
• 7 Roeder HA, Moore TR, Wolfson MT, Gamst AC, Ramos GA. Treating hyperglycemia in early pregnancy: a randomized controlled trial. Am J Obstet Gynecol MFM 2019; 1 (01) 33-41
• 8 Osmundson SS, Norton ME, El-Sayed YY, Carter S, Faig JC, Kitzmiller JL. Early screening and treatment of women with prediabetes: a randomized controlled trial. Am J Perinatol 2016; 33 (02) 172-179
• 9 Harper LM, Jauk V, Longo S, Biggio JR, Szychowski JM, Tita AT. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222 (05) 495.e1-495.e8
• 10 American Diabetes Association. 2. classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42 (Suppl. 01) S13-S28
• 11 Coustan DR, Carpenter MW. The diagnosis of gestational diabetes. Diabetes Care 1998; 21 (Suppl. 02) B5-B8
• 12 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 13 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
• 14 WHO Mutlicentre Growth Reference Study Group. WHO child growth standards: length/height-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Accessed November 17, 2021 at: https://www.who.int/childgrowth/standards/technical_report/en/
• 15 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
• 16 Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res 2020; 22 (01) e16204
• 17 Hong WY, Biggio JR, Tita A, Harper LM. Impact of early screening for gestational diabetes on perinatal outcomes in high-risk women. Am J Perinatol 2016; 33 (08) 758-764
• 18 Feghali MN, Abebe KZ, Comer DM, Caritis S, Catov JM, Scifres CM. Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract 2018; 138: 177-186
• 19 Immanuel J, Simmons D. Screening and treatment for early-onset gestational diabetes mellitus: a systematic review and meta-analysis. Curr Diab Rep 2017; 17 (11) 115
• 20 Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358 (19) 2003-2015
• 21 Powe CE. Early pregnancy biochemical predictors of gestational diabetes mellitus. Curr Diab Rep 2017; 17 (02) 12