Background:
We have maintained a Diabetes Pregnancy Database of prospectively collected demographic and outcome data in a high Gestational Diabetes (GDM) risk patient cohort for many years.
Aim:
To examine the characteristics and outcomes of our patients diagnosed by ADIPS 2014 GDM criteria.
Methods:
We analysed de-identified demographic and outcome data from all GDM pregnancies (Mar2016-Mar2024) where birth outcome data were available. All women received appropriate education from a Dietitian and a Diabetes Educator, undertook Self Monitoring of Blood Glucose QID, were reviewed by our Multi-Disciplinary Team including Endocrinologists weekly/fortnightly, and received insulin if treatment targets were not met (FBGL<5.3mmol/L, 1hrBGL<7.4, 2hrBGL<7.0). Metformin was not used. Amongst the singleton pregnancies, characteristics assessed included relevant demographic, clinical and laboratory findings and outcomes assessed included insulin use, caesarean section, early delivery (<37weeks), large for gestational age (LGA) (>90th percentile), small for gestational age (SGA) (<10th percentile), neonatal hypoglycaemia (<2.6mmol/L) and neonatal jaundice (requiring phototherapy). Data on breastfeeding were available for 74% of these women (see Table).
Results:
Over eight years, there were 3250 GDM pregnancies: 14 miscarriages, 13 stillbirths, 52 twin and 3171 singleton births, with characteristics/outcomes of the latter shown in the Table. Three quarters were non-European and there were similar percentages of women across four major ethnicity groups, representing 92.9% of the cohort. Almost one quarter were primigravida and the mean gestational age at diagnosis was 23.6±5.9 weeks. Mean pre-pregnancy BMI, (based on self-reported weight) was 27.1±6.1 kg/m2, with over 58% overweight or obese. Early delivery occurred in 6.5%, with over a third delivered by caesarean section (42.4% emergency). Breastfeeding rate on discharge was 88.9%. The LGA rate was 12.5%.
|
|
Singleton GDM Births mean±SD or n(%) total=3171 |
|
Maternal |
|
|
Maternal Age (years) |
31.4±5.3 |
|
Gestational Age at diagnosis (weeks) |
23.6±5.9 |
|
Gravida |
2.9±1.8 |
|
Parity |
1.3±1.4 |
|
Primigravida |
776 (24.5) |
|
Grand multiparity (>5) |
97 (3.0) |
|
Middle Eastern ethnicity |
798 (25.2) |
|
European ethnicity |
777 (24.5) |
|
East/Southeast Asian ethnicity |
727 (22.9) |
|
South Asian ethnicity |
645 (20.3) |
|
Other ethnicities |
224 (7.1) |
|
OGTT fasting (mmol/L) |
5.1±1.2 |
|
OGTT 1-hour (mmol/L) |
9.8±2.0 |
|
OGTT 2-hour (mmol/L) |
7.9±1.8 |
|
HbA1c (%) |
5.2±0.4 |
|
Pre-pregnancy Maternal BMI (kg/m2) |
27.1±6.1 |
|
Underweight (<18.5kg/m2) |
93 (2.9) |
|
Healthy Weight (18.5-24.9kg/m2) |
1228 (38.7) |
|
Overweight (25.0-29.9kg/m2) |
988 (31.2) |
|
Obese (>30.0kg/m2) |
862 (27.2) |
|
Total Gestational Weight Gain (kg) |
11.9±6.5 |
|
Outcomes |
|
|
Insulin Use |
1509 (47.6) |
|
Maximum Total Insulin Dose |
29.5±29.9 |
|
Caesarean Section |
1136 (35.8) |
|
Planned/Emergency Caesarean (%) |
(57.6 / 42.4) |
|
Early Delivery |
207 (6.5) |
|
LGA |
395 (12.5) |
|
SGA |
251 (7.9) |
|
Neonatal Hypoglycaemia |
339 (10.7) |
|
Neonatal Jaundice |
179 (5.6) |
|
Breast Feeding at discharge (of n=2354) |
2092 (88.9) |
Conclusions:
Amongst our multicultural GDM patient cohort, nearly 60% were overweight or obese. Almost half the women required insulin therapy to attain LGA rates similar to those of the background 10% risk in non-GDM cohorts.