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Review paints more accurate picture of gestational-diabetes risks for mother and baby

NEW YORK 03/06 - Gestational diabetes mellitus (GDM) increases the risk of a range of complications for both mother and baby, including cesarean delivery, respiratory distress and excessive birth weight, according to a new systematic review and meta-analysis.

The incidence of GDM is increasing and this analysis provides a "more comprehensive" picture of potential adverse pregnancy outcomes, the authors write in The BMJ.

Dr. Fangkun Liu and colleagues from Central South University in China analyzed data from 156 studies involving more than 7.5 million pregnancies that reported complications of pregnancy in women with GDM.

In studies without insulin use, after adjusting for confounders, women with GDM (versus no GDM) had significantly increased odds of cesarean delivery (odds ratio, 1.16), preterm delivery (OR, 1.51), low one-minute Apgar score (OR, 1.43), macrosomia (OR, 1.70) and having a large for gestational age infant (OR, 1.57).

In studies with insulin use, after adjusting for confounders, women with GDM had significantly higher odds of having an infant that was large for gestational age (OR, 1.61), had respiratory distress syndrome (OR, 1.57), neonatal jaundice (OR, 1.28) or required admission to the neonatal intensive-care unit (OR, 2.29).

There was no clear evidence for differences in the likelihood of instrumental delivery, shoulder dystocia, postpartum hemorrhage, stillbirth, neonatal death, low five-minute Apgar score, low birth weight, or small for gestational age between women with and without GDM after adjusting for confounders.

"These findings support the need for an improved understanding of the pathophysiology of gestational diabetes mellitus to inform the prediction of risk and for precautions to be taken to reduce adverse outcomes of pregnancy," Dr. Liu and colleagues conclude.

Looking ahead, they say future studies "should routinely consider adjusting for a more complete set of prognostic factors."

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