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First pregnancy risk factors and future gestational diabetes mellitus
Israel Yoles1,2, Eyal Sheiner3, Tamar Wainstock4
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. yoles@netvision.net.il.
Insights
Complications in a first pregnancy, including hypertensive disorders, perinatal mortality, maternal obesity, and fetal macrosomia, significantly increase the risk of gestational diabetes mellitus (GDM) in a subsequent pregnancy. Early GDM detection is recommended for women with these prior complications.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Health
- Maternal-Fetal Medicine
Background:
- Gestational diabetes mellitus (GDM) affects approximately 17% of pregnancies, posing risks to both mother and child.
- Early diagnosis and intervention are crucial for mitigating adverse outcomes associated with GDM.
Purpose of the Study:
- To identify characteristics from a first pregnancy that serve as risk factors for developing GDM in a subsequent pregnancy.
- To inform targeted screening and management strategies for women at higher risk of GDM.
Main Methods:
- A population-based nested case-control study involving women with two consecutive singleton pregnancies.
- Comparison of first pregnancy characteristics and complications between women who developed GDM in their second pregnancy and those who did not.
- Multivariable logistic regression analysis to assess the association between first pregnancy complications and subsequent GDM, adjusting for confounders.
Main Results:
- 1.9% of 38,750 women developed GDM in their second pregnancy.
- First pregnancy complications such as hypertensive disorders, perinatal mortality, maternal obesity, and fetal macrosomia were significantly associated with increased GDM risk in the second pregnancy.
- The adjusted odds ratio for GDM increased by 2.33 with one complication and 5.38 with two or more complications from the first pregnancy.
Conclusions:
- Specific first pregnancy complications are significant predictors of GDM in subsequent pregnancies.
- Women experiencing hypertensive disorders, perinatal mortality, maternal obesity, or fetal macrosomia in their first pregnancy should be considered for early GDM screening in future pregnancies.
- These findings support proactive monitoring and intervention for high-risk pregnancies to improve maternal and infant outcomes.
Purpose:
Gestational diabetes mellitus (GDM) affect about 17% of all pregnancies and is associated with significant short- and long-term health consequences for the mother and her offspring. Early diagnosis and prompt interventions may reduce these adverse outcomes. We aimed to identify first pregnancy characteristics as risk factors for GDM in subsequent pregnancy.
Materials And Methods:
A population-based nested case-control study was conducted in a large tertiary hospital. The study population included all women with two singleton consecutive pregnancies and deliveries, without GDM in the first pregnancy. Characteristics and complications of the first pregnancy were compared among cases and controls. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and GDM in the subsequent pregnancy, while adjusting for confounding variables.
Results:
A total of 38,750 women were included in the study, of them 1.9% (n = 728) had GDM in their second pregnancy. Mothers with GDM in their second pregnancy were more likely to have the following first pregnancy complications: hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia. Results remained significant after adjustment for maternal age and inter-pregnancy interval. Having either one of the complications increased the risk for GDM by 2.33 (adjusted OR = 2.33; 95% CI 1.93-2.82) while a combination of two complications increased GDM risk by 5.38 (adjusted OR = 5.38; 95% CI 2.85-10.17).
Conclusions:
First pregnancy without GDM complicated by hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia was associated with an increased risk for GDM in the subsequent pregnancy. Women with these complications may benefit from early detection of GDM in their subsequent pregnancy.
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