Previous research has established that GDM is a principal factor in adverse pregnancy outcomes both in the United States and globally, and as the incidence of obesity continues to increase, the prevalence of GDM is projected to surge. However, due to limited research, there are knowledge gaps with regard to assessing the independent correlations between GDM and adverse outcomes.
In a recent publication in Cureus, researchers conducted a retrospective study and wrote, “This study aims to investigate the specific impact of GDM, irrespective of maternal socioeconomic status. By conducting a retrospective analysis of deliveries involving women with GDM in the United States, we intend to establish profiles of women with GDM and assess GDM as a primary predictor of adverse maternal and neonatal outcomes.”
The researchers examined data between January 2015 and December 2019 from the United States Vital Statistics Records database, which contains comprehensive information on births and deaths in the U.S.
The analysis included 19,249,237 deliveries documented during the allotted time frame, and the study cohort included women of all races/ethnicities. The researchers excluded participants with missing critical data, such as maternal race/ethnicity, BMI, and age, and evaluated pregnancy outcomes from the study. The researchers employed a multivariate analysis that merged factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and to interpret the correlation between GDM and the outcomes of interest.
The results revealed that between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Based on racial/ethnic groups, among women with GDM, 46.4% were non-Hispanic whites, 11.4% were non-Hispanic blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The average age of women with GDM was 31 years, with an interquartile range of 27 to 35 years. Among these women, the cesarean section rate was 46.5%.
Based on the results, GDM was recognized as “an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR [odds ratio] = 1.40; 95% CI, 1.39-1.40), maternal blood transfusion (OR = 1.15; 95% CI, 1.12-1.18), intensive care unit admission (OR = 1.16; 95% CI 1.10-1.21), neonatal intensive care unit admission (OR = 1.53; 95% CI, 1.52-1.54), assisted ventilation (OR = 1.37; 95% CI, 1.35-1.39), and low 5-minute Apgar score (OR = 1.01; 95% CI, 1.00-1.03).”
Based on their findings, the authors wrote, “We observed that GDM patients tended to be older, consistent with previous research indicating that advanced maternal age is a risk factor for GDM.”
The authors also added, “Our study found the highest prevalence of GDM among obese women, corroborating existing literature on the relationship between BMI and GDM risk. This association may be due to insulin resistance caused by higher BMI and lifestyle factors. Interestingly, we noted a significant decrease in GDM incidence with increased weight gain in pregnancy. This counter-intuitive trend might suggest metabolic adaptations or physiological changes in pregnancy aiding glucose regulation. However, this observation warrants a deeper inquiry, underscoring the need for further comprehensive research on this complex relationship.”
The authors noted that women with GDM were more likely to undergo a cesarean section, which was comparable with previous research findings, and GDM consistently appears as an independent predictor of adverse pregnancy outcomes among all evaluated maternal and neonatal outcomes.
The authors concluded that findings from the study demonstrate meaningful relationships between GDM and augmented risks of adverse maternal and neonatal outcomes. They also noted that their findings emphasized the significance of early identification and appropriate management of GDM in pregnant women to potentially diminish complications for both mother and child.
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Published July 11, 2023
