Basilio Pintaudi1, Raffaella Fresa2, Mariagrazia Dalfrà3, Alessandro Roberto Dodesini4, Ester Vitacolonna5, Andrea Tumminia6, Laura Sciacca6, Cristina Lencioni7, Teresa Marcone8, Giuseppe Lucisano9, Antonio Nicolucci9, Matteo Bonomo10, Angela Napoli11. 1. SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy. basilio.pintaudi@ospedaleniguarda.it. 2. Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy. 3. Diabetology, Colli-ULSS16, Padua, Italy. 4. Papa Giovanni XXIII Hospital, Bergamo, Italy. 5. Department of Medicine and Aging, D'Annunzio University, Chieti-Pescara, Italy. 6. Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy. 7. Diabetes Unit, Usl Nord Ovest Toscana, Lucca, Italy. 8. SSD Diabetology, University Hospital, Foggia, Italy. 9. COREsearch, Pescara, Italy. 10. SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy. 11. S. Andrea Hospital, Sapienza University, Rome, Italy.
Abstract
AIMS: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. RESULTS: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight). CONCLUSIONS: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.
AIMS: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. RESULTS: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight). CONCLUSIONS: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.
Authors: Shamil D Cooray; Lihini A Wijeyaratne; Georgia Soldatos; John Allotey; Jacqueline A Boyle; Helena J Teede Journal: Int J Environ Res Public Health Date: 2020-04-27 Impact factor: 3.390