Preconceptional Risk Factors Associated With Gestational Diabetes Mellitus and Pregnancy Outcomes: A Case-Control...

Gestational diabetes mellitus (GDM) is a major endocrine problem complicating pregnancy worldwide, and pregnancies complicated by GDM are associated with adverse birth outcomes. This study aimed to identify preconceptional risk factors and birth outcomes associated with GDM.

A hospital-based case-control study was conducted among antenatal mothers seeking routine antenatal care at selected maternity hospitals in Khurdha district, Odisha, India. The study comprised 143 women with GDM and 143 gestational age-matched controls. Data were collected using a structured questionnaire and interviews. Data were entered and analyzed using SPSS, version 21 (IBM Corp., Armonk, NY).

The point prevalence of GDM in the study population was 9.9%. The preconceptional risk factors, such as preconception body mass index (BMI) (odds ratio (OR) = 3.01, 95% confidence interval (CI): 1.78-5.09, P < 0.001), sedentary lifestyle (OR = 2.79, 95% CI: 1.33-5.88, P = 0.00), previous history of diabetes (OR = 3.72, 95% CI: 1.33-10.39, P = 0.00), family history of diabetes (OR = 1.94, 95% CI: 1.16-3.24, P = 0.01), and domestic violence (OR = 2.14, 95% CI: 1.13-4.06, P = 0.02) had significantly higher odds of developing GDM compared with non-GDM women. In relation to the obstetrical risk factors, early age at menarche (≤12 years) (OR = 2.79, 95% CI: 1.72-4.54, P < 0.001), previous history of GDM (OR = 2.42, 95% CI: 1.06-5.52, P = 0.03), primipara mothers (OR = 2.21, 95% CI: 1.38-3.56, P = 0.001), previous history of macrosomia (OR = 16.6, 95% CI: 2.16-127.76, P < 0.001), history of preterm delivery (OR = 2.78, 95% CI: 1.35-5.69, P = 0.004), and history of using steroid medications (OR = 2.42, 95% CI: 1.06-5.52, P = 0.03) increased the likelihood of developing GDM in the subsequent pregnancy. Furthermore, GDM was significantly associated with antepartum depression and adverse intrapartum and neonatal outcomes. Women with GDM had significantly higher odds of developing maternal depression (OR = 2.55, 95% CI: 1.45-4.50, P = 0.001), cesarean delivery (OR = 2.92, 95% CI: 1.79-4.76, P < 0.001), and preterm delivery (OR = 1.94, 95% CI: 1.19-3.15, P = 0.00), and the need for induction of labor was significantly higher among women with GDM (OR = 4.11, 95% CI: 2.47-6.85, P < 0.001) compared with non-GDM women. With respect to neonatal outcomes, mothers with GDM had significantly higher odds of developing neonatal hyperbilirubinemia (OR = 7.05, 95% CI: 1.56-31.84, P = 0.01), neonatal hypoglycemia (OR = 14.00, 95% CI: 4.18-46.85, P = 0.001), giving birth to a macrosomia baby (OR = 32.97, 95% CI: 4.30-4235.35, P = 0.01), and being admitted to the neonatal intensive care unit (NICU) (OR = 5.68, 95% CI: 3.34-9.64, P = 0.001).

It was shown that maternal preconception lifestyle risk factors and poor obstetric factors were associated with GDM in the subsequent pregnancy and with unfavorable pregnancy-related outcomes. Preconception counseling, along with need-based appropriate management, is highly important for addressing modifiable risk factors and reducing unfavorable birth outcomes associated with GDM.