Key result
An adverse outcome in an index gestational diabetes pregnancy was associated with a higher risk of the same complication in a subsequent pregnancy (RR 2.10, 95% CI 1.53-2.87 for composite ANO).
Why the study?
The study was conducted to compare the risk of recurrent adverse delivery outcome or adverse neonatal outcome between consecutive gestational diabetes pregnancies.
Does an adverse outcome in an index GDM pregnancy increase the risk of recurrent adverse outcomes in a subsequent GDM pregnancy?
Cohort (n=424)
Does an adverse outcome in an index GDM pregnancy increase the risk of recurrent adverse outcomes in a subsequent GDM pregnancy?
Relative Risk: 2.1 (95% CI 1.53–2.87)
Women with gestational diabetes who experience an adverse delivery or neonatal outcome are at a significantly higher risk of recurrent complications in subsequent pregnancies.
History of prior adverse GDM outcome predicts recurrence; leaves open whether risk-stratified interventions reduce repeat events.
Objective: Compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies. Design: Retrospective cohort Setting: Sydney, Australia Population or Sample: 424 pairs of consecutive singleton GDM pregnancies, 2003-2015 Main Outcome Measures:. ADO: instrumental delivery and emergency Caesarean. ANO: large for gestational age (LGA), small for gestational age (SGA), and composite ANO (LGA/SGA/stillbirth/neonatal death/shoulder dystocia). Methods: Using each pregnancy pair (“index” and “subsequent” pregnancy), we calculated ADO and ANO rates and determined risk factors for subsequent pregnancy outcomes (multivariate regression). Results: Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p<0.001) and lower rates of instrumental delivery (5% vs 13.9%, p<0.001), emergency Caesarean (7.1% vs 16.3%, p<0.001) and vaginal delivery (62.3% vs 66.3%, p=0.01). ANO rates in index and subsequent pregnancies did not differ. Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30, 7.34) for instrumental delivery, RR 2.20 (95%CI:1.06, 4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03, 6.82) for LGA, RR 5.01 (95%CI:2.73, 9.22) for SGA and RR 2.10 (95%CI:1.53, 2.87) for composite ANO). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20, 4.47)), SGA (RR 4.71 (95%CI:2.66, 8.36)) or composite ANO (RR 2.01 (95%CI:1.46, 2.78)) was having the same outcome in the index pregnancy. Conclusions: Women with GDM and an adverse outcome are at very high risk of the same complication in their subsequent GDM pregnancy, representing a high-risk group that should be targeted for directed management over routine care.
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Lau et al. (2021) conducted a cohort in Gestational diabetes (n=424). Adverse outcome in index pregnancy vs. No adverse outcome in index pregnancy was evaluated on Composite adverse neonatal outcome (LGA/SGA/stillbirth/neonatal death/shoulder dystocia) (RR 2.10, 95% CI 1.53, 2.87). An adverse outcome in an index gestational diabetes pregnancy was associated with a higher risk of the same complication in a subsequent pregnancy (RR 2.10, 95% CI 1.53-2.87 for composite ANO).
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