Top

Published in:

Open Access 01-12-2018 | Research article

Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study

Authors: Grzegorz Domanski, Anja Erika Lange, Till Ittermann, Heike Allenberg, Robert Andreas Spoo, Marek Zygmunt, Matthias Heckmann

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Abstract

Background

Gestational diabetes mellitus (GDM) is the most frequent complication during pregnancy. Untreated GDM is a severe threat to maternal and neonatal health. Based on recent evidence, up to 15% of all pregnancies may be affected by GDM. We hypothesized that in a rural birth cohort, higher maternal BMI and adverse socioeconomic conditions would promote GDM, which in turn would lead to adverse effects on pregnancy outcomes.

Methods

The current study is a part of a population-based cohort study examining the health and socioeconomic information from 5801 mothers and their children. The study, titled the Survey of Neonates in Pomerania (SNiP), was based in northeastern Pomerania, Germany (2002–2008).

Results

The cumulative incidence of GDM was 5.1%. Multiple logistic regression revealed prepregnancy overweight (OR 1.84 (95% CI 1.27–2.68)), prepregnancy obesity (OR 3.67 (2.48–5.44)) and maternal age (OR 1.06 (1.03–1.08)) as risk factors for GDM (p = 0.001). Alcohol use during pregnancy (OR 0.61 (0.41–0.90), a higher monthly income (OR 0.62 (0.46–0.83)), and the highest level of education (OR 0.44 (0.46–0.83)) decreased the risk of GDM.

Newborns of GDM mothers had an increased risk of hypoglycaemia (OR 11.71 (7.49–18.30)) or macrosomia (OR 2.43 (1.41–4.18)) and were more often delivered by primary (OR 1.76 (1.21–2.60)) or secondary C-section (OR 2.00 (1.35–2.97)). Moreover, they were born 0.78 weeks (95% CI -1.09 – -0.48 weeks) earlier than infants of mothers without diabetes, resulting in higher percentage of late preterm infants with a gestational age of 32–36 weeks (11.1% vs. 6.96%).

Conclusions

Age and BMI before pregnancy were the predominant mediators of the increased risk of GDM, whereas a higher income and educational level were protective. GDM affected relevant perinatal and neonatal outcomes based on its association with an increased risk of delivery by C-section, preterm birth, macrosomia at birth and neonatal hypoglycaemia.

Kleinwechter H, Schäfer-Graf U, Bührer C, Hoesli I, Kainer F, Kautzky-Willer A, et al. Gestationsdiabetes mellitus (GDM): Evidenzbasierte Leitlinie zu Diagnostik, Therapie u. Nachsorge der Deutschen Diabetes-Gesellschaft (DDG) und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG); 2011.

AQUA – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH. Bundesauswertung zum Verfahrensjahr 2010 16/1 – Geburtshilfe Qualitätsindikatoren.: Erstellt am: 15.06.2011–21/201120003; 2011.

Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin N Am. 2007;34:173–99, vii. https://doi.org/10.1016/j.ogc.2007.03.002 .CrossRef

Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract. 2003;62:131–7.CrossRefPubMed

International Diabetes Federation. IDF diabetes atlas. Brussels: International Diabetes Federation; 2015.

Melchior H, Kurch-Bek D, Mund M. The prevalence of gestational diabetes — a population-based analysis of a nationwide screening program. Dtsch Arztebl Int. 2017;114:412–7. https://doi.org/10.3238/arztebl.2017.0412 .PubMedPubMedCentralCrossRef

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. https://doi.org/10.1056/NEJMoa0707943 .CrossRefPubMed

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86. https://doi.org/10.1056/NEJMoa042973 .CrossRefPubMed

Oldfield MD, Donley P, Walwyn L, Scudamore I, Gregory R. Long term prognosis of women with gestational diabetes in a multiethnic population. Postgrad Med J. 2007;83:426–30. https://doi.org/10.1136/pgmj.2006.056267 .CrossRefPubMedPubMedCentral

10.

Dalfrà MG, Lapolla A, Masin M, Giglia G, Dalla Barba B, Toniato R, Fedele D. Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Diabetes Metab. 2001;27:675–80.PubMed

11.

Jecht M. Hyperglykämie und negative Auswirkungen auf den Schwangerschaftsausgang in der HAPO-Studie. Diabetologe. 2009;5:216–8. https://doi.org/10.1007/s11428-009-0417-x .CrossRef

12.

Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115:e290–6. https://doi.org/10.1542/peds.2004-1808 .CrossRefPubMed

13.

Yessoufou A, Moutairou K. Maternal diabetes in pregnancy: early and long-term outcomes on the offspring and the concept of "metabolic memory". Exp Diabetes Res. 2011;2011:218598. https://doi.org/10.1155/2011/218598 .CrossRefPubMedPubMedCentral

14.

Bouthoorn SH, Silva LM, Murray SE, Steegers EAP, Jaddoe VWV, Moll H, et al. Low-educated women have an increased risk of gestational diabetes mellitus: the generation R study. Acta Diabetol. 2015;52:445–52. https://doi.org/10.1007/s00592-014-0668-x .CrossRefPubMed

15.

Bo S, Menato G, Bardelli C, Lezo A, Signorile A, Repetti E, et al. Low socioeconomic status as a risk factor for gestational diabetes. Diabetes Metab. 2002;28:139–40.PubMed

16.

Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med. 2004;21:103–13.CrossRefPubMed

17.

Saldana TM, Siega-Riz AM, Adair LS. Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr. 2004;79:479–86.CrossRefPubMed

18.

Hosler AS, Nayak SG, Radigan AM. Stressful events, smoking exposure and other maternal risk factors associated with gestational diabetes mellitus. Paediatr Perinat Epidemiol. 2011;25:566–74. https://doi.org/10.1111/j.1365-3016.2011.01221.x .CrossRefPubMed

19.

Poulain T, Baber R, Vogel M, Pietzner D, Kirsten T, Jurkutat A, et al. The LIFE child study: a population-based perinatal and pediatric cohort in Germany. Eur J Epidemiol. 2017;32:145–58. https://doi.org/10.1007/s10654-016-0216-9 .CrossRefPubMed

20.

Jaddoe VWV, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EAP, et al. The generation R study: design and cohort update until the age of 4 years. Eur J Epidemiol. 2008;23:801–11. https://doi.org/10.1007/s10654-008-9309-4 .CrossRefPubMed

21.

John U, Greiner B, Hensel E, Lüdemann J, Piek M, Sauer S, et al. Study of health in Pomerania (SHIP): a health examination survey in an east German region: objectives and design. Soz Praventivmed. 2001;46:186–94.CrossRefPubMed

22.

Kurth B-M, Kamtsiuris P, Hölling H, Schlaud M, Dölle R, Ellert U, et al. The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-study. BMC Public Health. 2008;8:196. https://doi.org/10.1186/1471-2458-8-196 .CrossRefPubMedPubMedCentral

23.

Ebner A, Thyrian JR, Lange A, Lingnau M-L, Scheler-Hofmann M, Rosskopf D, et al. Survey of neonates in Pomerania (SNiP): a population-based birth study--objectives, design and population coverage. Paediatr Perinat Epidemiol. 2010;24:190–9. https://doi.org/10.1111/j.1365-3016.2009.01078.x .CrossRefPubMed

24.

Lange AE, Thyrian JR, Wetzka S, Flessa S, Hoffmann W, Zygmunt M, et al. The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study. BMC Pregnancy Childbirth. 2016;16:197. https://doi.org/10.1186/s12884-016-0966-0 .CrossRefPubMedPubMedCentral

25.

Bundesausschuss der Ärzte und Krankenkassen. Guidelines of the Federal Committee of Physicians and Health Insurance Funds on medical care during pregnancy and after delivery ("Maternity Guidelines"): Richtlinien des Bundesausschusses der Ärzte und Krankenkassen über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“); 1999.

26.

Voigt M, Rochow N, Schneider KTM, Hagenah H-P, Scholz R, Hesse V, et al. Neue Perzentilwerte für die Körpermaße neugeborener Einlinge: Ergebnisse der deutschen Perinatalerhebung der Jahre 2007-2011 unter Beteiligung aller 16 Bundesländer. Z Geburtshilfe Neonatol. 2014;218:210–7. https://doi.org/10.1055/s-0034-1385857 .CrossRefPubMed

27.

Bauer K. Schneider KTM. Berlin: Leitlinie zur Betreuung von Neugeborenen diabetischer Mütter; 2003.

28.

McNamee R. Confounding and confounders. Occup Environ Med. 2003;60:227–34.CrossRefPubMedPubMedCentral

29.

Hagenaars A, Vos Kd, Zaidi MA. Poverty statistics in the late 1980s: Research based on micro-data. Luxembourg: Off. of Official Publ. of the Europ. Communities; 1994.

30.

Huy C, Loerbroks A, Hornemann A, Röhrig S, Schneider S. Prevalence, trend and determining factors of gestational diabetes in Germany. Geburtshilfe Frauenheilkd. 2012;72:311–5. https://doi.org/10.1055/s-0031-1298390 .CrossRefPubMedPubMedCentral

31.

Rendtorff R, Hinkson L, Kiver V, Droge LA, Henrich W. Pregnancies in women aged 45 years and older - a 10-year retrospective analysis in berlin. Geburtshilfe Frauenheilkd. 2017;77:268–75. https://doi.org/10.1055/s-0043-100105 .CrossRefPubMedPubMedCentral

32.

Kuo C-H, Chen S-C, Fang C-T, Nien F-J, Wu E-T, Lin S-Y, et al. Screening gestational diabetes mellitus: the role of maternal age. PLoS One. 2017;12:e0173049. https://doi.org/10.1371/journal.pone.0173049 .CrossRefPubMedPubMedCentral

33.

Abouzeid M, Versace VL, Janus ED, Davey M-A, Philpot B, Oats J, Dunbar JA. Socio-cultural disparities in GDM burden differ by maternal age at first delivery. PLoS One. 2015;10:e0117085. https://doi.org/10.1371/journal.pone.0117085 .CrossRefPubMedPubMedCentral

34.

Landon MB, Rice MM, Varner MW, Casey BM, Reddy UM, Wapner RJ, et al. Mild gestational diabetes mellitus and long-term child health. Diabetes Care. 2015;38:445–52. https://doi.org/10.2337/dc14-2159 .CrossRefPubMed

35.

Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, Crowther CA. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care. 2010;33:964–8. https://doi.org/10.2337/dc09-1810 .CrossRefPubMedPubMedCentral

36.

Silva LM, Coolman M, Steegers EAP, Jaddoe VWV, Moll HA, Hofman A, et al. Maternal educational level and risk of gestational hypertension: the generation R study. J Hum Hypertens. 2008;22:483–92. https://doi.org/10.1038/jhh.2008.22 .CrossRefPubMed

37.

Campbell EE, Gilliland J, Dworatzek PDN, de Vrijer B, Penava D, Seabrook JA. Socioeconomic status and adverse birth outcomes: a population-based Canadian sample. J Biosoc Sci. 2017:1–12. https://doi.org/10.1017/S0021932017000062 .

38.

Anna V, van der Ploeg HP, Cheung NW, Huxley RR, Bauman AE. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008;31:2288–93. https://doi.org/10.2337/dc08-1038 .CrossRefPubMedPubMedCentral

39.

Lee D-Y, Yoo M-G, Kim H-J, Jang HB, Kim J-H, Lee H-J, Park SI. Association between alcohol consumption pattern and the incidence risk of type 2 diabetes in Korean men: a 12-years follow-up study. Sci Rep. 2017;7:7322. https://doi.org/10.1038/s41598-017-07549-2 .CrossRefPubMedPubMedCentral

40.

Holst C, Becker U, Jørgensen ME, Grønbæk M, Tolstrup JS. Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population. Diabetologia. 2017; https://doi.org/10.1007/s00125-017-4359-3 .

41.

Dandrow RV, O'Sullivan JB. Obstetric hazards of gestational diabetes. Am J Obstet Gynecol. 1966;96:1144–7. https://doi.org/10.1016/0002-9378(66)90525-4 .CrossRefPubMed

42.

HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9. https://doi.org/10.2337/db08-1112 .CrossRef

43.

von Katterfeld B, Li J, McNamara B, Langridge AT. Maternal and neonatal outcomes associated with gestational diabetes in women from culturally and linguistically diverse backgrounds in Western Australia. Diabet Med. 2012;29:372–7. https://doi.org/10.1111/j.1464-5491.2011.03483.x .CrossRef

44.

Boardman JP, Wusthoff CJ, Cowan FM. Hypoglycaemia and neonatal brain injury. Arch Dis Child Educ Pract Ed. 2013;98:2–6. https://doi.org/10.1136/archdischild-2012-302569 .CrossRefPubMed

45.

Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics. 2008;122:65–74. https://doi.org/10.1542/peds.2007-2822 .CrossRefPubMed

46.

Tam EWY, Haeusslein LA, Bonifacio SL, Glass HC, Rogers EE, Jeremy RJ, et al. Hypoglycemia is associated with increased risk for brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy. J Pediatr. 2012;161:88–93. https://doi.org/10.1016/j.jpeds.2011.12.047 .CrossRefPubMedPubMedCentral

47.

Ferrara A, Weiss NS, Hedderson MM, Quesenberry CP, JR SJV, Ergas IJ, et al. Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia. Diabetologia. 2007;50:298–306. https://doi.org/10.1007/s00125-006-0517-8 .CrossRefPubMed

48.

Maayan-Metzger A, Lubin D, Kuint J. Hypoglycemia rates in the first days of life among term infants born to diabetic mothers. Neonatology. 2009;96:80–5. https://doi.org/10.1159/000203337 .CrossRefPubMed

49.

Lowe WL, Bain JR, Nodzenski M, Reisetter AC, Muehlbauer MJ, Stevens RD, et al. Maternal BMI and Glycemia impact the fetal metabolome. Diabetes Care. 2017;40:902–10. https://doi.org/10.2337/dc16-2452 .CrossRefPubMedPubMedCentral

50.

Sharp GC, Salas LA, Monnereau C, Allard C, Yousefi P, Everson TM, et al. Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation: findings from the pregnancy and childhood epigenetics (PACE) consortium. Hum Mol Genet. 2017;26:4067–85. https://doi.org/10.1093/hmg/ddx290 .CrossRefPubMedPubMedCentral

51.

Logan CA, Thiel L, Bornemann R, Koenig W, Reister F, Brenner H, et al. Delivery mode, duration of labor, and cord blood adiponectin, leptin, and C-reactive protein: results of the population-based Ulm birth cohort studies. PLoS One. 2016;11:e0149918. https://doi.org/10.1371/journal.pone.0149918 .CrossRefPubMedPubMedCentral

52.

Smith LK, Draper ES, Evans TA, Field DJ, Johnson SJ, Manktelow BN, et al. Associations between late and moderately preterm birth and smoking, alcohol, drug use and diet: a population-based case-cohort study. Arch Dis Child Fetal Neonatal Ed. 2015;100:F486–91. https://doi.org/10.1136/archdischild-2014-307265 .CrossRefPubMedPubMedCentral

53.

Pfinder M, Kunst AE, Feldmann R, van Eijsden M, Vrijkotte TGM. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies BMC Pregnancy Childbirth. 2013;13:49. https://doi.org/10.1186/1471-2393-13-49 .CrossRefPubMed

Title: Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study
Authors: Grzegorz Domanski
Anja Erika Lange
Till Ittermann
Heike Allenberg
Robert Andreas Spoo
Marek Zygmunt
Matthias Heckmann
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-018-2005-9

At a glance: The STEP trials

Springer Medicine

Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Associations between social capital and maternal depression: results from a follow-up study in China

The effect of pre-pregnancy hair dye exposure on infant birth weight: a nested case-control study

Effects of inter-twin vascular anastomoses of monochorionic twins with selective intrauterine growth restriction on the contents of placental mitochondria DNA

A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo

Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B+

Gestational weight gain in Chinese women -- results from a retrospective cohort in Changsha, China