MedicalResearch.com Interview with:
Dr Sophie Jacqueminet
Service de Diabétologie
Pole Cardio Métabolisme
Pitié Salpêtrière – Charles Foix
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The proportion of women who are overweight or obese is increasing in almost all countries worldwide, and this is being accompanied by an increased risk of developing both type 2 diabetes (T2D) (whether pregnant or not) and gestational diabetes (GDM). While other studies have analysed the links between GDM and adverse outcomes in babies, very large studies that draw on an entire national database, study, are rare.
In our research, all 796,346 deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.
The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with gestational diabetes mellitus. Data linking the mother to the child were available for 705,198 deliveries (88% of the total). The risks of adverse outcomes were two to four times higher for babies of mothers with type 2 diabetes before pregnancy (pregestational diabetes) than for those with GDM. We then adjusted our data, limiting the analysis to deliveries after 28 weeks to ensure all women diagnosed with GDM were included (since diagnosis of GDM in most cases takes place at or after 28 weeks).
Following adjustment, the increased risk of various complications for mothers with gestational diabetes versus mothers without GDM were: preterm birth 30%; Caesarean section 40%; pre-eclampsia/eclampsia 70%; babies born significantly larger than average size (macrosomia) 80%; respiratory distress 10%; birth trauma 30%; and cardiac malformations 30%. While these increased risks combine women with both insulin- and diet-treated GDM, most of the increased risk is found in women with insulin-treated GDM. This is because as stated above, the diabetes is more serious and blood sugar more difficult to control in women who need insulin treatment, resulting in a higher risk of complications than in those women treated with diet only.
After limiting the analysis to normal-term deliveries (37 weeks), an increased risk of death of the newborn baby was observed in women with gestational diabetes. After excluding women suspected to have undiagnosed T2D before pregnancy, the risk remained moderately increased only for those women with diet-treated GDM, with a 30% increased risk of the baby dying. We suggest that this difference in risk of death could be because those women with diet-treated GDM tend to give birth later than those who are insulin-treated, meaning the unborn child is exposed to higher glucose levels for longer.
MedicalResearch.com: What should readers take away from your report?
Response: We have clearly demonstrated that gestational diabetes is a disease related to adverse pregnancy outcomes and that most of the risks are higher in women with insulin-treated gestational diabetes. By restricting analysis to deliveries after 37 weeks and excluding cases of type 2 diabetes that were undiagnosed before pregnancy, we identified a moderate increase in risk of death to the newborn baby in women with gestational diabetes treated with diet only.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Although more investigation is needed, this study helps illuminate the controversy about timing of delivery in gestational diabetes pregnancy.
MedicalResearch.com: Is there anything else you would like to add?
Response: Screening and management of gestational diabetes become an essential issue.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Billionnet, C., Mitanchez, D., Weill, A. et al. Diabetologia (2017). doi:10.1007/s00125-017-4206-6Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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