Pregnancy outcomes in women aged 35 years or older with gestational diabetes – a registry-based study in Finland

Abstract

Objective: To compare pregnancy outcomes of women ≥35 years to women <35 years with and without gestational diabetes.

Methods: The data include 230 003 women <35 years and 53 321 women ≥35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28–31 and 32–36 weeks' gestation), Apgar scores <7 at 5 min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA).

Results: In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30–1.88), admission to the NICU (OR 3.30, CI 2.94–3.69) and shoulder dystocia (OR 2.12, CI 1.05–4.30) were highest in insulin-treated women ≥35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73–3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant.

Conclusions: GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.

• Advanced maternal age
• birth outcomes
• diet-treated GDM
• insulin-treated GDM
• normal glucose tolerance
• register-based study

Declaration of interest

The authors report no declarations of interest.

This study was supported by the University of Eastern Finland, Department of Nursing Science, The Finnish Doctoral Education Network in Nursing Science and the Emil Aaltonen Foundation. The funding institutions were not involved in the study design, interpretation of results, manuscript preparation, or the decision to submit the article for publication. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.