Abstract
Objective
This prospective study evaluated the impact of gestational diabetes on maternal and
fetal outcome in a large cohort of women with gestational diabetes mellitus (GDM)
followed up using standardized clinical criteria.
Study design
Between 1999 and 2003, we collected 3465 GDM women from 31 Italian regional obstetric
or diabetes centers, recording the time and mode of delivery, gestational hypertension,
pre-eclampsia, eclampsia, congenital malformations, and neonatal mortality, comparing
findings with the Italian general pregnant population.
Results
The rate of cesarean sections was 34.9% and macrosomia 8.7% (33.2 and 7.4%, respectively,
in the general population, p = ns). The stillbirth and neonatal mortality rates were no different in GDM patients
and normal pregnancies (0.34% vs. 0.30%, p = 0.176 and 0.29% vs. 0.32%, p = 0.748), but the former had twice as many newborn with congenital malformations (2.05%
vs. 0.89%, p < 0.01; CI 1.64–2.62). A prognostic model for the outcome of pregnancy was built and
the concurrent occurrence of several conditions was deemed as a positive outcome.
Pregnancies which did not meet one or more of the above criteria were classified as
“complicated”. On multivariate logistic analysis, only the week of gestation when
GDM was diagnosed and prepregnancy BMI were independent predictors of a complicated
pregnancy.
Conclusion
When correctly diagnosed and treated during pregnancy, women with GDM have a pregnancy
outcome similar to the general pregnant population, except for a greater likelihood
of congenital malformations in the newborn, probably due to unrecognized prior diabetes.
Prepregnancy obesity plays an important part in raising the risk of adverse perinatal
outcomes in GDM patients.
Keywords
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Article info
Publication history
Published online: May 12, 2009
Accepted:
April 21,
2009
Received:
October 29,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
