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Abstract
Background According to The Hyperglycemia and Adverse Pregnancy Outcome Study (HAPO Study) 2008, hyperglycemia caused by maternal gestational diabetes mellitus (GDM) is an important contributor to adverse fetal programming and maternal complications.
Aim To assess the associations between the GDM and perinatal outcomes.
Design The study comprised 228 women who were divided into two groups: Group 1 (Gr1) included 157 women with GDM, group 2 (Gr2) - 71 women without GDM. The diagnosis of GDM has been confirmed according to the HAPO criteria. Retrospective analysis of pregnancy, delivery and early neonatal period were performed. Newborn anthropometric characteristics were assessed and interpreted according to INTERGROWTH-21st recommendations. Statistical significance was estimated using Mann–Whitney U and chi-squared tests.
Results The rate of vaginal deliveries in both groups was similar (Gr1 81.7%; Gr2 73.5%, p = 0.19). The presence of GDM was associated with an increased risk of obstetric injuries (OR 4.1, 95% CI 1.9–8.5; p = 0.00004) and hypoglycemia in the newborn (OR 5.4, 95% CI 2.2–13.1; p = 0.00002). No significant differences were found in birth weight (Gr1: Me 3500 ± 400 g vs Gr2: Me 3450 ± 500 g, p = 0.7), birth length (Gr1: Me 52 ± 0.2 cm vs Gr2: Me 52 ± 0.2 cm, p = 0,3), weight/length ratio (Gr1: Me 6.7 ± 0.5 kg/cm vs Gr2: Me 6.6 ± 0.7 kg/cm, p = 0.9) and head circumference (Gr1: Me 35.2 ± 2.3 cm vs Gr2: Me 35.0 ± 1.3 cm, p = 0.05). The risk of being born with ‘upper average’ weight was associated with presence of maternal GDM (> 1 SDS <2 SDS) (OR 2.47; 95% CI 1.2–5.1; p = 0.01). However, no association was found between GDM and neonatal weight exceeding 2 SDS, known as ‘macrosomia’ (OR 1.1; 95% CI 0.3–3.7; p = 0.83). Maternal GDM was also associated with increased risk of neonatal head circumference in the ‘upper average’ range (> 1 SDS) (OR 2.4; 95% CI 1.4–5.9; p = 0.005).
Conclusion Maternal GDM was associated with increased risk of obstetric injuries, which can be explained by higher rates of increased newborn weight and head circumference. However, there was no increased number of children with macrosomia born to GDM mothers, which indicates a limited impact of GDM on fetal development compared to diabetes type 1 or 2. Neonatal hypoglycemia was associated with maternal GDM as well.