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Increased risk for babies born to mothers with gestational diabetes

New research published in Diabetologia (the journal of the European Association for the Study of the Diabetes [EASD]) shows an increased risk of adverse outcomes in babies born to mothers with gestational diabetes, when compared to others.

 

The study:

  • included all 796,346 deliveries taking place after 22 weeks in France in 2012
  • contained 57,629 (7.24%) mothers with GDM
  •  had available data linking the mother to the child for 705,198 deliveries (88% of the total)
  • noted that insulin was used to treat 25% of mothers with serious or hard to control GDM.

 

The authors adjusted their data, limiting the analysis to deliveries after 28 weeks to ensure all women diagnosed with GDM were included (since diagnosis of GDM in most cases takes place at or after 28 weeks).

 

Findings for deliveries after 28 weeks

The increased risk of various complications for mothers with GDM versus mothers without GDM were:

  • preterm birth 30%;
  • Caesarean section 40%;
  • pre-eclampsia/eclampsia 70%;
  • babies born significantly larger than average size (macrosomia) 80%;
  • respiratory distress 10%;
  • birth trauma 30%;
  • and cardiac malformations 30%.

 

While these increased risks combine women with both insulin- and diet-treated GDM, most of the increased risk was found in women with insulin-treated GDM. This is because diabetes is more serious and blood glucose more difficult to control in women who need insulin treatment, resulting in a higher risk of complications than in those women treated with diet only.

 

The researchers then limited the analysis to normal-term deliveries (37 weeks), showing an increased risk of death of the newborn baby in women with GDM.

 

After excluding women suspected to have undiagnosed T2D before pregnancy, the researchers noted:

  • a moderate increased risk of the baby dying for those women with diet-treated GDM (possibly because the unborn child is exposed to higher glucose levels for longer)
  • increased risk of cardiac malformations for women with insulin-treated GDM
  • decreased risk of nervous system malformations: one hypothesis is that early exposure of the embryo to abnormally high glucose levels has different effects on cardiac and nervous system tissues.

 

The study conclusion: "We have clearly demonstrated that GDM is a disease related to adverse pregnancy outcomes and that most of the risks are higher in women with insulin-treated GDM. By restricting analysis to deliveries after 37 weeks and excluding cases of type 2 diabetes that were undiagnosed before pregnancy, we identified a moderate increase in risk of death to the newborn baby in women with GDM treated with diet only. Although more investigation is needed, this study helps illuminate the controversy about timing of delivery in GDM pregnancy."

 

The study is by Dr Sophie Jacqueminet, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), France; Professor Delphine Mitanchez, Armand Trousseau Hospital, AP-HP, Paris, France; and Cécile Billionnet, French National Health Insurance, Paris, France, and colleagues.

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