Impact of risk factors on maternal outcomes in pregnancies complicated with gestational diabetes mellitus

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Ressource 1Download: Mémoire no 5618 M. Touray.pdf (427.61 [Ko])
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Serval ID
serval:BIB_AF06157949B0
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Impact of risk factors on maternal outcomes in pregnancies complicated with gestational diabetes mellitus
Author(s)
TOURAY J.
Director(s)
PUDER J.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2018
Language
english
Number of pages
25
Abstract
Background
Gestational diabetes mellitus (GDM) is defined as an alteration of the glucose metabolism during pregnancy. GDM is a common pregnancy complication affecting over 17% of all pregnancies and is associated with maternal and neonatal morbidity. Universal screening is widely the norm.
Objective
The present study was performed to investigate the impact of the presence- or lack - of risk factors on maternal outcomes in pregnancies complicated with GDM, during pregnancy and after delivery. We investigated this in the context of a regular care including capillary glucose management, lifestyle modification, treatment if indicated, which may impact some of the outcomes.
Material and methods
This study included 673 pregnant women diagnosed with GDM according to the International Society of Diabetes in Pregnancy Study Group (IADSPG) criteria with a 75g oral glucose tolerance test (OGTT) performed at 24-28 weeks of gestational age.
Anthropometric and metabolic characteristics were assessed for each participant. Risk factors were chosen based on the recommendation of the American Diabetes Association (ADA), their known impact on the risk of GDM, their prevalence and the feasibility to define them clearly in routine clinical care. These included: previous GDM, first degree relatives with type 2 diabetes mellitus (T2DM), ethnicity with high diabetes prevalence, overweight and/or obesity. The presence of maternal, mostly metabolic outcomes such as the need for any medical glucose treatment (regardless if insulin or metformin), HbA1c level, FBG and 2h BG values after the 75g OGTT 6-8 weeks post-partum as well as the mode of delivery were prospectively recorded according to these individual risk factors as well as according to the presence or absence of any risk factor. We tested for normal distribution for continuous variables. Logistic regression and linear regression were used to compare dichotomous variables and continuous variables respectively. Outcomes are expressed as odds ratio and β coefficient. The latter, if statistically significant, means that for every 1-unit increase in the predictive factor, the outcome variable will increase by the β coefficient value.
Results
The mean age was 32.9 (± 5.4). Women with a previous history of GDM had significantly higher values of HbA1c at the first GDM appointment (β coefficient 0.22 [0.11-0.33]), at the end of pregnancy (β coefficient 0.17 [-0.2-0.36]), and at 6-8 weeks post-partum (β coefficient 0.18 [0.08-0.28]). Same was found for fasting blood glucose (FBG) (β coefficient 0.26 [0.10-0.42]), 2h-BG (β coefficient 0.89 [0.42-1.36]) levels during the OGTT at 6-8 weeks post-partum. The need for medical glucose treatment was greater in women with this RF (OR 1.97 [1.07-3.06]).
5
Women with history of first-degree relatives with T2DM had significantly higher values of HbA1c at the first GDM appointment (β coefficient 0.11 [0.05-0.18]), at the end of pregnancy (β coefficient 0.16 [0.06-0.27]) as well as 2h-BG (β coefficient 0.34 [0.05-0.62]) levels post-partum. The need to treat was greater in women with the RF (OR 1.52 [1.08-2.14]).
Women with a high-risk non-Caucasian ethnicity had higher values of HbA1c at the first GDM appointment (β coefficient 0.09 [0.32-0.17]) and at 6-8 weeks post-partum (β coefficient 0.11 [0.04-0.17]). The same was found for post-partum FBG (β coefficient 0.13 [0.01-0.22]), and 2h-BG (β coefficient 0.45 [0.17-0.72]) levels. Women with this RF were more likely to need medical glucose treatment (OR 1.51 [1.08-2.14]).
Overweight and/or obese women had significantly higher values of HbA1c at the first GDM appointment (β coefficient 0.15 [0.09-0.21]) and at 6-8 weeks post-partum (β coefficient 0.09 [0.04-0.15]). The same was found for FBG (β coefficient 0.27 [0.18-0.36]), 2h-BG (β coefficient 0.33 [0.06-0.59]) levels during the OGTT at 6-8 weeks post-partum. The need for medical glucose-lowering treatment was greater in women with this RF (OR 1.74 [1.26-2.40]).
Obese women had significantly higher values of HbA1c at the first GDM appointment (β coefficient 0.15 [0.07-0.22]), at the end of pregnancy (β coefficient 0.15 [0.01-0.25]), and at 6-8 weeks post-partum (β coefficient 0.11 [0.04-0.18]). The same was found for FBG (β coefficient 0.17 [0.07-0.28]) levels during the OGTT at 6-8 weeks post-partum. The need for medical glucose treatment was greater in women with this RF (OR 1.67 [1.12-2.48]).
Women with at least one risk factor had more likely elevated HbA1c level at the first GDM consultation (β coefficient 0.14 [0.07-0.21]), at the end of pregnancy (β coefficient 0.11 [0.01-0.22]) and at 6-8-week post-partum (β coefficient 0.11 [0.04-0.17]). Similar increase was found for fasting, 1 and 2h-BG. Women with a risk factor were more frequently treated pharmacologically.
Conclusion
Women with an history of GDM and with first degree relative with type 2 diabetes mellitus and women of high-risk ethnicity and overweight/obese women have more frequent adverse pregnancy and maternal metabolic outcomes during and after pregnancy. Surprisingly none of these risk factors are associated with an increase of caesarean delivery in pregnancies complicated with GDM in the setting of routine clinical care and few are associated with a difference of metabolic control at the end of pregnancy.
Keywords
Gestational diabetes mellitus, Predictive factors, Risk factors, Maternal outcome
Create date
03/09/2019 10:19
Last modification date
08/09/2020 6:10
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