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Kouhkan, A., Najafi, L., Malek, M., Reza Baradaran, H., Hosseini, R., Khajavi, A., & Ebrahim Khamseh, M. (2021). Gestational diabetes mellitus: Major risk factors and pregnancy-related outcomes: A cohort study. International Journal of Reproductive BioMedicine (IJRM), 19(9), 827-836. https://doi.org/10.18502/ijrm.v19i9.9715
https://doi.org/10.18502/ijrm.v19i9.9715
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- Cited by 13 articles
authors
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Azam Kouhkan
Azam Kouhkan
Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Laily Najafi
Laily Najafi
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Mojtaba Malek
Mojtaba Malek
Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Hamid Reza Baradaran
Hamid Reza Baradaran
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Roya Hosseini
Roya Hosseini
Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Alireza Khajavi
Alireza Khajavi
Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mohammad Ebrahim Khamseh
Mohammad Ebrahim Khamseh
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
Published Date
- Oct 10, 2021
Gestational diabetes mellitus: Major risk factors and pregnancy-related outcomes: A cohort study
Abstract
Background: Gestational diabetes mellitus (GDM) is a major pregnancy endocrine problem that has several confirmed risk factors and is associated with adverse pregnancy-related outcomes (PRO).
Objective: To evaluate the relationship between GDM diagnosis and the associated risk factors of PRO (maternal, intrapartum, perinatal, and neonatal) in accordance with International Association of Diabetes and Pregnancy Study Groups criteria.
Materials and Methods: This prospective cohort study was performed with 531 singleton parturient (265 GDM and 266 non-GDM). They were selected consecutively from referral hospitals, and the maternal, intrapartum, perinatal, and neonatal outcomes were assessed.
Results: The major risk factors influencing the GDM diagnosis were maternal age, obesity, family history of diabetes, previous history of GDM, and previous history of macrosomia. In the comparison of PRO between the groups, significant associations were detected for emergency cesarean delivery, preeclampsia, polyhydramnios, premature rupture of membrane, preterm delivery, and neonatal hyperbilirubinemia in the GDM group. In the multivariate logistic regression analysis, a previous history of stillbirth was significantly associated with maternal and perinatal outcomes. The odds ratios (CI 95%) of the PRO in the women with a GDM diagnosis were: maternal = 2.43 (1.51-3.90), intrapartum = 2.05 (1.35- 3.11), perinatal = 2.00 (1.29-3.10), and neonatal = 1.68 (1.08-2.62). The PRO was significantly correlated with GDM diagnosis, but not with the risk factors.
Conclusion: The adverse pregnancy outcomes were significantly correlated with GDM diagnosis, and the outcomes were not directly affected by the risk factors. Given the related adverse outcomes for mothers and offspring, early screening and management of GDM is necessary especially in Asians and in low-/middle-income countries.
Key words: Gestational diabetes mellitus, Pregnancy outcomes, Risk factors.
References
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[2] Logakodie S, Azahadi O, Fuziah P, Norizzati B, Tan SF, Zienna Z, et al. Gestational diabetes mellitus: The prevalence, associated factors and foeto-maternal outcome of women attending antenatal care. Malays Fam Physician 2017; 12: 9–17.
[3] Miao M, Dai M, Zhang Y, Sun F, Guo X, Sun G. Influence of maternal overweight, obesity and gestational weight gain on the perinatal outcomes in women with gestational diabetes mellitus. Sci Rep 2017; 7: 305.
[4] Erem C, Kuzu UB, Deger O, Can G. Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: The trabzon GDM study. Arch Med Sci 2015; 11: 724–735.
[5] Lowe Jr WL, Scholtens DM, Kuang A, Linder B, Lawrence JM, Lebenthal Y, et al. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): Maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42: 372–380.
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[8] Alijahan R, Hazrati S, Mirzarahimi M, Pourfarzi F, Ahmadi Hadi P. Prevalence and risk factors associated with preterm birth in Ardabil, Iran. Iran J Reprod Med 2014; 12: 47–56.
[9] Henriksen T. The macrosomic fetus: A challenge in current obstetrics. Acta Obstet Gynecol Scand 2008; 87: 134–145.
[10] Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr 2011; 2012: 321545.
[11] Hossein-nezhad A, Mirzaei Kh, Ahmadi S, Maghbooli Zh, Karimi F. Comparison of incidence of pregnancy induced hypertension in gestational diabetes mellitus and healthy pregnant women. Iranian Journal of Diabetes and Lipid Disorders 2011; 10: 1–9.
[12] Krukowski RA, West DS, DiCarlo M, Shankar K, Cleves MA, Saylors ME, et al. Are early first trimester weights valid proxies for preconception weight? BMC Pregnancy Childbirth 2016; 16: 357.
[13] American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 2015; 38 (Suppl.): S8–S16.
[14] Metzger BE, Buchanan ThA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the fifth international workshopconference on gestational diabetes mellitus. Diabetes Care 2007; 30 (Suppl.): S251–S260.
[15] ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002; 99: 159–167.
[16] Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonat Med 2017; 22: 36–41.
[17] Pichon JBL, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: Definitions, diagnosis and treatment of the kernicterus spectrum disorders (KSDs). Curr Pediatr Rev 2017; 13: 199– 209.
[18] Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013 update. Neonatology 2013; 103: 353–368.
[19] Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: A clinical update. World J Diabetes 2015; 6: 1065–1072.
[20] Jenum AK, Sommer Ch, Sletner L, Mørkrid K, Bærug A, Mosdøl A. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: A review. Food Nutr Res 2013; 57: 18889.
[21] Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YCh, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: A systematic review and metaanalysis. BMC Pregnancy Childbirth 2018; 18: 494.
[22] Avalos GE, Owens LA, Dunne F, Collaborators AD. Applying current screening tools for gestational diabetes mellitus to a European population: Is it time for change? Diabetes Care 2013; 36: 3040–3044.
[23] Keshavarz M, Cheung NW, Babaee GhR, Kalalian Moghadam H, Ajami ME, Shariati M. Gestational diabetes in Iran: Incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 2005; 69: 279–286.
[24] Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod 2000; 15: 2433–2437.
[25] Korkmazer E, Solak N. Correlation between inflammatory markers and insulin resistance in pregnancy. J Obstet Gynaecol 2015; 35: 142–145.
[26] Nilofer AR, Raju VS, Dakshayini BR, Zaki SA. Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes. Indian J Endocrinol Metab 2012; 16 (Suppl.): S74–S78.
[27] Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res 2013; 137: 728–733.
[28] Fitria N, van Asselt ADI, Postma MJ. Cost-effectiveness of controlling gestational diabetes mellitus: A systematic review. Eur J Health Econ 2019; 20: 407–417.
[29] Kamana K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: A literature review. Ann Nutr Metab 2015; 66 (Suppl.): 14–20.
[30] Young BC, Ecker JL. Fetal macrosomia and shoulder dystocia in women with gestational diabetes: Risks amenable to treatment? Curr Diab Rep 2013; 13: 12–18.
[31] Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong Ch, et al. Hyperglycemia and adverse pregnancy outcome study: Neonatal glycemia. Pediatrics 2010; 126: e1545–e1552.
[32] Opara PI, Jaja T, Onubogu UC. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria. Ital J Pediatr 2010; 36: 77.
[2] Logakodie S, Azahadi O, Fuziah P, Norizzati B, Tan SF, Zienna Z, et al. Gestational diabetes mellitus: The prevalence, associated factors and foeto-maternal outcome of women attending antenatal care. Malays Fam Physician 2017; 12: 9–17.
[3] Miao M, Dai M, Zhang Y, Sun F, Guo X, Sun G. Influence of maternal overweight, obesity and gestational weight gain on the perinatal outcomes in women with gestational diabetes mellitus. Sci Rep 2017; 7: 305.
[4] Erem C, Kuzu UB, Deger O, Can G. Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: The trabzon GDM study. Arch Med Sci 2015; 11: 724–735.
[5] Lowe Jr WL, Scholtens DM, Kuang A, Linder B, Lawrence JM, Lebenthal Y, et al. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): Maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42: 372–380.
[6] International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan ThA, Catalano PA, et al. International Association of Diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–682.
[7] Sayehmiri F, Bakhtiyari S, Darvishi P, Sayehmiri K. [Prevalence of gestational diabetes mellitus in Iran: A systematic review and meta-analysis study]. The Iranian Journal of Obstetrics, Gynecology and Infertility 2013; 15: 16–23. (in Persian)
[8] Alijahan R, Hazrati S, Mirzarahimi M, Pourfarzi F, Ahmadi Hadi P. Prevalence and risk factors associated with preterm birth in Ardabil, Iran. Iran J Reprod Med 2014; 12: 47–56.
[9] Henriksen T. The macrosomic fetus: A challenge in current obstetrics. Acta Obstet Gynecol Scand 2008; 87: 134–145.
[10] Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr 2011; 2012: 321545.
[11] Hossein-nezhad A, Mirzaei Kh, Ahmadi S, Maghbooli Zh, Karimi F. Comparison of incidence of pregnancy induced hypertension in gestational diabetes mellitus and healthy pregnant women. Iranian Journal of Diabetes and Lipid Disorders 2011; 10: 1–9.
[12] Krukowski RA, West DS, DiCarlo M, Shankar K, Cleves MA, Saylors ME, et al. Are early first trimester weights valid proxies for preconception weight? BMC Pregnancy Childbirth 2016; 16: 357.
[13] American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 2015; 38 (Suppl.): S8–S16.
[14] Metzger BE, Buchanan ThA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the fifth international workshopconference on gestational diabetes mellitus. Diabetes Care 2007; 30 (Suppl.): S251–S260.
[15] ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002; 99: 159–167.
[16] Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonat Med 2017; 22: 36–41.
[17] Pichon JBL, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: Definitions, diagnosis and treatment of the kernicterus spectrum disorders (KSDs). Curr Pediatr Rev 2017; 13: 199– 209.
[18] Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013 update. Neonatology 2013; 103: 353–368.
[19] Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: A clinical update. World J Diabetes 2015; 6: 1065–1072.
[20] Jenum AK, Sommer Ch, Sletner L, Mørkrid K, Bærug A, Mosdøl A. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: A review. Food Nutr Res 2013; 57: 18889.
[21] Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YCh, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: A systematic review and metaanalysis. BMC Pregnancy Childbirth 2018; 18: 494.
[22] Avalos GE, Owens LA, Dunne F, Collaborators AD. Applying current screening tools for gestational diabetes mellitus to a European population: Is it time for change? Diabetes Care 2013; 36: 3040–3044.
[23] Keshavarz M, Cheung NW, Babaee GhR, Kalalian Moghadam H, Ajami ME, Shariati M. Gestational diabetes in Iran: Incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 2005; 69: 279–286.
[24] Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod 2000; 15: 2433–2437.
[25] Korkmazer E, Solak N. Correlation between inflammatory markers and insulin resistance in pregnancy. J Obstet Gynaecol 2015; 35: 142–145.
[26] Nilofer AR, Raju VS, Dakshayini BR, Zaki SA. Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes. Indian J Endocrinol Metab 2012; 16 (Suppl.): S74–S78.
[27] Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res 2013; 137: 728–733.
[28] Fitria N, van Asselt ADI, Postma MJ. Cost-effectiveness of controlling gestational diabetes mellitus: A systematic review. Eur J Health Econ 2019; 20: 407–417.
[29] Kamana K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: A literature review. Ann Nutr Metab 2015; 66 (Suppl.): 14–20.
[30] Young BC, Ecker JL. Fetal macrosomia and shoulder dystocia in women with gestational diabetes: Risks amenable to treatment? Curr Diab Rep 2013; 13: 12–18.
[31] Metzger BE, Persson B, Lowe LP, Dyer AR, Cruickshank JK, Deerochanawong Ch, et al. Hyperglycemia and adverse pregnancy outcome study: Neonatal glycemia. Pediatrics 2010; 126: e1545–e1552.
[32] Opara PI, Jaja T, Onubogu UC. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria. Ital J Pediatr 2010; 36: 77.