Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Gestational diabetes mellitus and adverse pregnancy outcomes: experience from Victoria’s largest healthcare service (#149)

Sally Abell 1 2 , Jacqueline Boyle 1 , Melanie Gibson-Helm 3 , Sanjeeva Ranasinha 3 , Georgia Soldatos 2 3 , Sophia Zoungas 2 3 , Helena Teede 1 2
  1. Monash Centre for Health Research and Implementation, Monash University, Melbourne
  2. Diabetes and Vascular Medicine Unit, Monash Health, Victoria
  3. Monash Centre for Health Research and Implementation, Monash University, Melbourne

To compare pregnancy outcomes of women with Gestational Diabetes Mellitus (GDM) and those without GDM [ADIPS 1998 diagnostic criteria].

A retrospective observational study of all births at Monash Health from 2009 to 2013 (n=38374) recorded in the longitudinal Birthing Outcomes System database was conducted. Antenatal characteristics, maternal and neonatal outcomes for those with ADIPS GDM (n=3018) and without ADIPS GDM (n=35356) were captured. 

Pregnancy outcomes were presented as rates occurring over the five year period. Multivariable regression analysis was used to detect associations between GDM and adverse pregnancy outcomes, adjusting for potential confounders including maternal age, baseline BMI, country of birth, gravidity, past history of GDM, and family history of diabetes.

Women with GDM were older (6.9% versus 3.5% age ≥40, p<0.001) and were more overweight at baseline (55.8% vs 45.3% BMI ≥ 25, p<0.001) compared to those without GDM. Thirty percent of women with GDM required insulin therapy. Rates of gestational hypertension, pre-eclampsia, pre-term delivery, macrosomia, shoulder dystocia and neonatal respiratory distress were similar between groups. Women with GDM had higher rates of induction of labour (30.7% vs 20.9%, p<0.001) and caesarean section (35% vs 26.9%, p<0.001) than those without GDM. Neonates of women with GDM had more hypoglycaemia (10.4% vs 4.7%, p<0.001), hyperbilirubinaemia (19.4% vs 17.0%, p<0.001) and required special care nursery admission (30.8% vs 19.4%, p<0.001) more frequently than those without GDM. Pregnancies with GDM had lower rates of stillbirth (0.4% vs 1.2%, p<0.001) and neonatal death (death prior to hospital discharge 0.1% vs 0.5%, p<0.001) compared to those without GDM.

Women with GDM have higher rates of obstetric intervention, and adverse neonatal outcomes of hypoglycaemia, hyperbilirubinaemia and special care nursery admission. However, pregnancies with GDM have lower rates of stillbirth and neonatal death. 

  1. Australian Diabetes in Pregnancy Society. Gestational diabetes mellitus – management guidelines. Med J Aust 1998;169:93-97.