Once Gestational diabetes, always Gestational diabetes? Maternal and neonatal outcomes of pregnancies with gestational diabetes preceding non gestational diabetes pregnancy- A retrospective cohort study.

Abstract

BACKGROUND There is limited information about maternal and neonatal outcomes of pregnant individuals without gestational diabetes mellitus (GDM), who were diagnosed with GDM in the preceding pregnancy. OBJECTIVE To investigate whether individuals previously diagnosed with GDM but not in subsequent pregnancy present similar diabetes-related complications, despite the lack of diagnosis Study Design: A retrospective cohort design was employed, including individuals with at least two consecutive births at a tertiary Medical Center between July 2012 and December 2022. Participants were categorized into three groups: individuals with GDM in both pregnancies (group 1), GDM in the first pregnancy but not in the subsequent pregnancy (group 2), and no GDM in both pregnancies (group 3). Groups were compared for various diabetes-related complications. RESULTS The study population comprised 19,703 individuals . Group 2 showed higher rates of macrosomia (OR 1.4, 95% CI 1.01-1.92, p=0.03) large-for-gestational-age (LGA) (OR 1.6, 95% CI 1.2-2.0, p<0.01) and preeclampsia (OR 2.35, 95% CI 1.32-4.15, p<0.01) when compared to group 3. Rates of LGA macrosomia and preeclampsia were similar between group 1 and 2. The composite maternal-neonatal adverse outcome was significantly elevated in groups 1 and 2 compared to group 3 (OR 1.48, 95% CI 1.23-1.77, p<0.01 and OR 1.91, 95% CI 1.58-2.3, p<0.01; respectively). In a multivariate regression, the adjusted OR (accounting for BMI before 2nd birth, age at 2nd birth and parity) for composite maternal-neonatal outcomes was 1.75 (95% CI 1.36-2.25, p<0.01) and 1.30 (95% CI 1.01-1.67, p=0.03) in groups 1 and 2 respectively, compared to group 3. Elective cesarean delivery rate was higher in groups 1 (22%) and 2 (13%) compared to group 3 (8.7%). However, the rate was also significantly higher in group 1 versus 2. Preterm birth rates were higher in group 1 (OR 1.7, 1.2-2.3, p<0.01) but not 2, when compared to group 3. CONCLUSIONS Individuals with a history of GDM in a previous pregnancy but not in subsequent pregnancy are at increased risk of diabetes-related complications, including preeclampsia, macrosomia, and LGA. The findings suggest that these individuals may have underlying insulin resistance, as well as other, still occurring, risk factors and their absence of a GDM diagnosis does not eliminate the risk of adverse outcomes. .