Download PDF
Am J Perinatol 2024; 41(03): 343-348
DOI: 10.1055/a-1682-2643
Original Article

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

Gianna Wilkie
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
,
Ellen Delpapa
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
,
Heidi Leftwich
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, Massachusetts
› Author Affiliations Funding This study was funded by grant# UL1TR001454.
› Further Information
    Permissions and Reprints

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


Publication History

Received: 01 April 2021

Accepted: 24 October 2021

Accepted Manuscript online:
28 October 2021

Article published online:
02 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Gestational diabetes mellitus. ACOG practice bulletin no. 190. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 131: e49-e64
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Coustan DR, Carpenter MW. The diagnosis of gestational diabetes. Diabetes Care 1998; 21 (Suppl. 02) B5-B8
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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/
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Powe CE. Early pregnancy biochemical predictors of gestational diabetes mellitus. Curr Diab Rep 2017; 17 (02) 12
    CrossrefPubMedGoogle Scholar