Obstet Gynecol Sci.  2018 May;61(3):309-318. 10.5468/ogs.2018.61.3.309.

The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center

• Kim M
• Park J
• Kim SH
• Kim YM
• Yee C
• Choi SJ
• Oh SY
• Roh CR

• KMID: 2416118
• DOI: http://doi.org/10.5468/ogs.2018.61.3.309

Abstract

OBJECTIVE
To investigate the change of maternal characteristics, delivery and neonatal outcomes in gestational diabetes mellitus (GDM) over recent 10 years and to identify the risk factors associated with adverse outcome.
METHODS
Consecutive GDM patients (n=947) delivered in our institution were included. Research period was arbitrarily divided into 2 periods (period 1: from 2006 to 2010, period 2: from 2011 to 2015). Multiple pregnancies or preexisting diabetes were excluded. Maternal baseline characteristics, delivery and neonatal outcomes were reviewed. Fetal biometric findings by prenatal ultrasonography were collected. Adverse pregnancy outcome (APO) was defined by the presence of one of the followings; shoulder dystocia, neonatal macrosomia (>4 kg), neonatal hypoglycemia (< 35 mg/dL), respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU) in term pregnancy.
RESULTS
Period 2 was associated with older maternal age (34 vs. 33, P < 0.001) and higher proportion of GDM A2 compared to period 1 (30.9% vs. 23.0%, P=0.009). By univariate analysis, APO was associated with increased body mass index (BMI) at pre-pregnancy (23.4 kg/m² vs. 21.8 kg/m², P=0.001) or delivery (27.9 kg/m² vs. 25.8 kg/m², P < 0.001), higher HbA1c at diagnosis (5.6% vs. 5.3%, P < 0.001) or delivery (5.8% vs. 5.5%, P=0.044), and larger fetal biometric findings (abdominal circumference [AC] and estimated fetal weight, P=0.029 and P=0.007, respectively). Multivariate analysis showed pre-pregnancy BMI (odds ratio [OR], 1.101; 90% confidence interval [CI], 1.028-1.180) and fetal AC (OR, 1.218; 90% CI, 1.012-1.466) were independently associated with adverse outcomes.
CONCLUSION
Our study demonstrated the trends and relevant factors associated with the adverse outcomes.

Keyword

Diabetes, gestational; Pregnancy outcome; Dystocia; Fetal macrosomia; Respiratory distress syndrome, newborn

MeSH Terms

Body Mass Index
Diabetes, Gestational*
Diagnosis
Dystocia
Female
Fetal Macrosomia
Fetal Weight
Humans
Hypoglycemia
Infant, Newborn
Intensive Care, Neonatal
Maternal Age
Multivariate Analysis
Pregnancy
Pregnancy Outcome
Pregnancy, Multiple
Respiratory Distress Syndrome, Newborn
Risk Factors*
Shoulder
Ultrasonography, Prenatal

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