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Obstetric and neonatal complications in large for gestational age pregnancy with late gestational diabetes
Shaymaa Kadhim Jasim1, Hayder Al-Momen2, Zina Ismaiel Mahdi3
1Department of Obstetrics and Gynecology, University of Baghdad, College of Medicine, Baghdad, Iraq
Insights
Late gestational diabetes (GDM) diagnosed in the third trimester is common in pregnancies with high fetal weight. While most complications were similar, cesarean section rates were significantly higher in women with late GDM.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Perinatology
Background:
- Gestational diabetes (GDM) is a growing concern, impacting fetal development and increasing perinatal risks.
- Early GDM diagnosis and management are crucial for maternal and fetal well-being.
Purpose of the Study:
- To determine the incidence of late GDM (LGDM) in the third trimester among pregnant women with ultrasonographically identified high fetal weight.
- To compare obstetric and neonatal complications between women with LGDM and those without, despite normal earlier glycemic control.
Main Methods:
- A prospective cohort study followed pregnant women with normal early glycemic control but high fetal weight identified in the third trimester.
- Women underwent an oral glucose tolerance test to diagnose LGDM, comparing outcomes between LGDM and non-LGDM groups.
Main Results:
- The incidence of LGDM in this cohort was 13.64%.
- While birth weight, large for gestational age rates, and gestational age at delivery were comparable, the cesarean section (CS) rate was significantly higher in the LGDM group (76.19% vs. 51.52%).
- Hemoglobin A1c levels were higher in the LGDM group (5.9% vs. 5.1%).
Conclusions:
- The study identified a notable rate of LGDM in the third trimester among women with high fetal weight.
- LGDM in the third trimester, despite normal earlier glycemic control, was associated with a significantly higher rate of cesarean sections compared to non-GDM pregnancies.
- These findings highlight the importance of monitoring for GDM even with previously normal glycemic control, particularly in the presence of suspected fetal macrosomia.
Objective:
Gestational diabetes (GDM) is increasing in prevalence with effects starting in-utero, leading to excessive fetal growth. It is the leading cause of many perinatal complications. The aim was to determine the rate of obstetric and neonatal complications in pregnant women with high fetal weight and a recent diagnosis of GDM during the third trimester, despite normal earlier glycemic control.
Material And Methods:
Prospective cohort study over four years involving pregnant women regularly visiting a single center who had normal glycemic index at 24-28 gestational weeks and ultrasonography (US) suggested high fetal weight during the third trimester. Oral glucose tolerance test was given, dividing the sample into the late GDM (LGDM) and the non-LGDM group.
Results:
Of 176 women, 24 (13.64%) had LGDM, and 152 (86.36%) had non-LGDM. After exclusions these groups' sizes were (n=21) in LGDM and (n=132) in non-LGDM. Hemoglobin A1c level was significantly higher in LGDM than non-LGDM (5.9% versus 5.1%). However, obstetric and neonatal complications were largely comparable (p≥0.05) but higher in LGDM than non-LGDM women. Exceptions to this were birth weight (3219 g versus 3326 g), large for gestational age at delivery (85.72% versus 88.64%), and gestational age at delivery (37.9 versus 38.2 weeks) in the LGDM vs. non-LGDM groups, respectively. There was a significantly higher cesarean section (CS) rate (76.19% versus 51.52%; p<0.05) in the LGDM group.
Conclusion:
The rate of newly diagnosed LGDM in pregnant women with high fetal weight during the third trimester by US was 13.64%. They had comparable obstetric and neonatal complications with non-GDM women, except for the rate of CS that was significantly higher in LGDM women.
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