Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes

Beenu Bastian; Lisa Gaye Smithers; Alexia Pape; Warren Davis; K Fu; Monique Francois

doi:10.1016/j.diabres.2024.111890

Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes

Diabetes Res Clin Pract. 2024 Nov:217:111890. doi: 10.1016/j.diabres.2024.111890. Epub 2024 Oct 19.

Authors

Beenu Bastian¹, Lisa Gaye Smithers², Alexia Pape³, Warren Davis⁴, K Fu⁵, Monique Francois⁶

Affiliations

¹ School of Medical Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. Electronic address: Beenu.Bastian@health.nsw.gov.au.
² School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia. Electronic address: lsmithers@uow.edu.au.
³ Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. Electronic address: alexia.pape@health.nsw.gov.au.
⁴ School of Medical Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Obstetrics and Gynaecology Department, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. Electronic address: warren.davis@health.nsw.gov.au.
⁵ Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. Electronic address: Kathy.fu@health.nsw.gov.au.
⁶ School of Medical Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia. Electronic address: francois@uow.edu.au.

PMID: 39433214
DOI: 10.1016/j.diabres.2024.111890

Abstract

Aims: To compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM).

Methods: In this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12-20 weeks) and by diagnostic fasting blood glucose as higher-FBG (5.3-6.0 mmol/L) and lower-FBG group (FBG 5.1-5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding.

Results: Risk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen.

Conclusions: Fasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.

Keywords: Early screening; Gestational diabetes mellitus; Outcomes; Pregnancy; Treatment.

Publication types

Observational Study

MeSH terms

Adult
Blood Glucose / analysis
Blood Glucose / metabolism
Diabetes, Gestational* / blood
Diabetes, Gestational* / diagnosis
Diabetes, Gestational* / epidemiology
Early Diagnosis*
Female
Fetal Macrosomia / diagnosis
Fetal Macrosomia / epidemiology
Gestational Age
Humans
Infant, Newborn
Infant, Small for Gestational Age
Pregnancy
Pregnancy Outcome* / epidemiology
Prenatal Diagnosis*

Substances

Blood Glucose