Impact of overt diabetes diagnosed in pregnancy in a multi-ethnic cohort in Spain

Abstract

Overt diabetes (ODM) is defined as women without diabetes meeting the criteria for diabetes at the first antenatal visit. The risk of obstetric complications increases linearly with maternal glycemia and poorer maternal-fetal outcomes than in gestational diabetes (GDM) may be expected. Studies focusing on ODM pregnancy outcomes are lacking. We aimed to analyze maternal characteristics and pregnancy outcomes in ODM women compared with those with GDM. A retrospective cohort study of women giving birth between January 2010 and April 2013 was conducted. Participants with pre-gestational diabetes were excluded. All women underwent screening for GDM at the 24th–28th weeks of gestation or at the first prenatal visit in those with risk factors. HbA1c and a fasting glucose were measured in GDM women to rule out ODM. Of the 5,633 women included, 572 (10%) were diagnosed with GDM and 50 (0.88%) with ODM. Almost 95% of ODM women were from ethnic minorities. After adjustment for confounding factors, ODM women showed increased rates of premature birth (23.1% vs. 6.7%, p < .001), emergent cesarean section (41.0% vs. 19.5%, p = .049), preeclampsia (22% vs. 3.7%, p < .001) and large-for-gestational-age babies (40.0% vs. 14.8%, p = .008) compared with GDM. In conclusion, ODM is associated with poorer obstetric outcomes than GDM and affects mainly women from ethnic minorities.

摘要

显性糖尿病(ODM)是指没有糖尿病的妇女在第一次产前检查中符合糖尿病的标准。与妊娠期糖尿病(GDM)相比, 随着孕妇血糖升高和母婴结局恶化, 产科并发症的风险可能呈线性增加。关注ODM妊娠结局的研究很少。我们的目的是分析ODM女性与GDM患者的母体特征和妊娠结局。对2010年1月至2013年4月期间分娩的妇女进行了一项回顾性队列研究。患有妊娠前糖尿病的参与者被排除在外。所有女性在妊娠第24-28周或有危险因素的患者在第一次产前检查中接受GDM筛查。在GDM女性中测量HbA1c和空腹血糖以排除ODM。在所有5,633名女性中, 572名（10％）被诊断患有GDM, 50名（0.88％）被诊断为ODM, 几乎95％的ODM女性来自少数民族。调整混杂因素后, ODM女性与GDM相比, 早产率（23.1％vs。6.7％, p <.001）, 紧急剖宫产率（41.0％vs。19.5％, p = .049）, 先兆子痫（22％vs, 3.7％, p <.001）和大于胎龄儿（40.0％对14.8％, p = .008）均增加。总之, 与GDM 相比, ODM与较差的产科结局相关, 并且主要影响少数民族妇女。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Overt diabetes
• gestational diabetes
• large-for-gestational-age
• cesarean section
• preeclampsia
• pregnancy outcome
• premature birth

Acknowledgments

Preliminary data of the present study was presented at the 51st European Association for the Study of Diabetes annual meeting, Stockholm, Sweden, 14–18 September 2015. We thank Miss Christine O’Hara for review of the English version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.