Having gestational diabetes mellitus (GDM) spells health complications for mothers and their newborns. A study by French researchers published in Diabetologia, the journal of the European Association for the Study of the Diabetes, found that GDM mothers were more likely to suffer from poorer health outcomes than nondiabetic mothers and that babies born to women with the condition had moderately higher death rates.
Rising obesity rates and other demographics are contributing to a rising GDM incidence in French women, the study’s authors observed. Previous studies have looked at the adverse health outcomes associated with GDM in infants.
“Data on GDM derived from exhaustive national or regional databases that link maternal and neonatal outcomes are relatively rare, and the overall risk of morbidity of neonates born to GDM mothers remains unclear, particularly for neonates with congenital malformations and respiratory distress,” they noted.
To cast a wider net, researchers drew information from the French hospital discharge database and the French National Health Insurance system to examine more than 796,000 deliveries that occurred after 22 weeks in 2012. Factors such as the administration of glucose-lowering drugs at various stages of pregnancy, data on long-term diseases, and hospital diagnoses at delivery, determined the diabetic status of the mothers. More than 7% of deliveries involved mothers with GDM, and researchers in 88% of cases were able to link data for mothers and their newborns.
Compared with GDM mothers, women who had type 2 diabetes prior to pregnancy had a much higher risk of birthing babies with poor health outcomes. To get a closer look at the GDM mothers, the study’s authors restricted their analysis to deliveries after 28 weeks, as GDM diagnosis often occurs after this point in a pregnancy. The differences in health outcomes between GDM and non-GDM mothers became clear after making these adjustments in the data.
According to a statement summarizing the study’s findings, GDM mothers compared with non-GDM mothers had a 70% increased risk of developing pre-eclampsia/eclampsia, and an 80% risk of birthing newborns with macrosomia. GDM mothers were also more at risk for having a Caesarean section or a preterm birth, and their babies were more likely to experience cardiac malformations, birth trauma, or respiratory distress.
Risks for certain health complications increased in the event mothers were treated with insulin. This was the case for preterm deliveries, Caesarean sections, and macrosomia. “The excess risk of cardiac malformations and respiratory distress observed in the GDM group was also due to the insulin-treated GDM group,” the researchers indicated.
In a separate analysis that looked at deliveries after 37 weeks of pregnancy, researchers found that perinatal deaths in the operating room were 30% higher in the GDM group, when compared with the no diabetes cohort. “This risk was similar whether or not the diabetes was insulin-treated. No significant differences were observed for the other outcomes in deliveries after 28 weeks,” according to the study.
The results definitively show a link between poor health outcomes and pregnant women with GDM, and that insulin treatment increases the risk of developing a health complication, the authors concluded. “Although more investigation is needed, this study helps illuminate the controversy about timing of delivery in GDM pregnancy.”