Elsevier

Obstetrics & Gynecology

Volume 90, Issue 6, December 1997, Pages 869-873
Obstetrics & Gynecology

Original Articles
Pregnancy Outcomes in Women With Gestational Diabetes Compared With the General Obstetric Population

https://doi.org/10.1016/S0029-7844(97)00542-5Get rights and content

Abstract

Objective: To compare pregnancy outcome in a homogeneous group of women with glucose intolerance with that of women without this disorder.

Methods: This was a retrospective cohort study of all women with singleton cephalic-presenting pregnancies delivered at University of Texas Southwestern Medical Center during the period January 1, 1991, through December 31, 1995. During this period, women were screened selectively for glucose intolerance and National Diabetes Data Group thresholds were used to diagnose gestational diabetes. Women with class A1 gestational diabetes were compared with nondiabetic women within the cohort. Effects of confounding variables were analyzed using multiple logistic regression and a matched-control comparison. Controls were matched according to ethnicity, maternal age, maternal weight, and parity.

Results: A total of 61,209 nondiabetic women with singleton cephalic pregnancies were delivered during the study period, and 874 were diagnosed with class A1 gestational diabetes. Women with class A1 gestational diabetes were significantly older, heavier, of greater parity, and more often of Hispanic ethnicity. Hypertension (17 versus 12%), cesarean delivery (30 versus 17%), and shoulder dystocia (3 versus 1%) were significantly increased (all P < .001) in these women compared with the general obstetric population. Infants born to women with class A1 gestational diabetes were significantly larger (mean birth weight 3581 ± 616 versus 3290 ± 546 g, P < .001), and this accounted for the increased incidence of dystocia. The attributable risk for large for gestational age (LGA) infants due to class A1 gestational diabetes was 12%.

Conclusion: The main consequence of class A1 gestational diabetes is excessive fetal size leading to increased risk of difficult labor and delivery. We estimate that approximately one of eight women with class A1 gestational diabetes mellitus delivers an LGA infant attributable to glucose intolerance.

Section snippets

Materials and Methods

Pregnant women with risk factors for gestational diabetes received 50-g oral glucose screening tests in one of nine community prenatal clinics serving Parkland Hospital in Dallas. Risk factors for immediate screening at any time during pregnancy included glucosuria, a random serum glucose concentration of 130 mg/dL or more (all antepartum women had serum glucose measured on presentation for prenatal care), history of gestational diabetes, concurrent risk factors such as macrosomia or

Results

Between January 1, 1991, and December 31, 1995, 874 women were diagnosed as having class A1 gestational diabetes and singleton cephalic-presenting pregnancies. The main indications for glucose screening in these women included family history (39%), prior delivery of a macrosomic infant (19%), glucosuria (18%), previous gestational diabetes (9%), and a random serum glucose concentration of 130 mg/dL or more (5.7%). The mean (± standard deviation) gestational age at diagnosis was 31.6 ± 5 weeks.

Discussion

We have concluded from this analysis of a large cohort of pregnancies that women with class A1 gestational diabetes have significantly different pregnancy characteristics and outcomes. Women with glucose intolerance are significantly older, larger, and more often Hispanic than those without class A1 gestational diabetes. Pregnancy interventions such as induction of labor were increased because preeclampsia supervened more often in women with class A1 gestational diabetes. Their infants were

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