Polyhydramnios at Term in Gestational Diabetes: Should We Be Concerned?

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics
• Perinatology

Background:

• Idiopathic polyhydramnios complicates pregnancies, elevating maternal and perinatal risks.
• Gestational diabetes mellitus (GDM) is a common pregnancy complication.
• The interplay between GDM and polyhydramnios requires further investigation.

Purpose of the Study:

• To investigate the implications of polyhydramnios in term pregnancies diagnosed with GDM.
• To assess the association between amniotic fluid volume (AFV) measurements and adverse maternal/perinatal outcomes in GDM pregnancies.

Main Methods:

• Prospective cohort study of 340 women with GDM at term (37-40 weeks).
• Amniotic fluid volume assessed using amniotic fluid index (AFI) and single deepest pocket (SDP).
• Maternal and perinatal outcomes analyzed, with comparisons between normal and polyhydramnios groups, and logistic regression for outcome associations.

Main Results:

• GDM pregnancies with polyhydramnios showed significantly higher risks of maternal (54.3% vs. 27.5%) and perinatal (65.7% vs. 46.5%) complications.
• Increased AFV was linked to higher rates of fetal overgrowth (LGA: 21.4%, macrosomia: 19.8%) and lower rates of small for gestational age (SGA) fetuses (6.3%).
• Both AFI and SDP correlated with newborn weight and centile; AFI demonstrated a stronger association with fetal overgrowth and reduced risk of SGA/IUGR.

Conclusions:

• Polyhydramnios detection in GDM pregnancies identifies a high-risk subgroup for obstetric and perinatal complications.
• Increased AFV (AFI ≥ 18 cm or SDP ≥ 6.5 cm) is associated with fetal overgrowth risk.
• Intensive monitoring and optimized delivery timing are recommended for GDM cases with increased AFV to improve perinatal outcomes.