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. 2017 Apr;60(4):636-644.
doi: 10.1007/s00125-017-4206-6. Epub 2017 Feb 15.

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

Cécile Billionnet  1 , Delphine Mitanchez  2   3 , Alain Weill  1 , Jacky Nizard  3   4 , François Alla  1 , Agnès Hartemann  3   5   6 , Sophie Jacqueminet  7   8
Affiliations

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

Cécile Billionnet et al. Diabetologia. 2017 Apr.

Abstract

Aims/hypothesis: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.

Methods: All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.

Results: The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).

Conclusions/interpretation: GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.

Keywords: Cardiac malformation; Gestational diabetes mellitus; Macrosomia; Perinatal death; Pre-eclampsia; Preterm.

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Conflict of interest statement

Data availability

We are unable to publicly provide the datasets owing to restrictions from our ethics committees, unless an agreement between all parties has been made.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

CB, DM, AW, AH, FA and SJ contributed to the concept and design of this study; CB, AW and FA contributed to data acquisition and analysis; and DM, SJ, AH, CB and JN contributed to data interpretation and to drafting the manuscript. All authors critically reviewed the manuscript and approved the final version. CB is the guarantor of this work.

Figures

Fig. 1
Fig. 1
Distribution of gestational age at delivery in the GDM group, according to maternal treatment and restricted to deliveries that occurred after 37 weeks of pregnancy. White bars, insulin-treated GDM; black bars, non-insulin-treated GDM
See this image and copyright information in PMC

References

    1. Catalano PM, Hauguel-De Mouzon S. Is it time to revisit the Pedersen hypothesis in the face of the obesity epidemic? Am J Obstet Gynecol. 2011;204:479–487. doi: 10.1016/j.ajog.2010.11.039. - DOI - PMC - PubMed
    1. Charles MA, Eschwege E, Basdevant A. Monitoring the obesity epidemic in France: the Obepi surveys 1997–2006. Obesity (Silver Spring) 2008;16:2182–2186. doi: 10.1038/oby.2008.285. - DOI - PMC - PubMed
    1. Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30:2070–2076. doi: 10.2337/dc06-2559a. - DOI - PubMed
    1. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. doi: 10.1056/NEJMoa0707943. - DOI - PubMed
    1. O’Sullivan EP, Avalos G, O’Reilly M, Dennedy MC, Gaffney G, Dunne F. Atlantic diabetes in pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia. 2011;54:1670–1675. doi: 10.1007/s00125-011-2150-4. - DOI - PubMed

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