Impact of previous gestational diabetes management on perinatal outcomes in subsequent pregnancies affected by gestational diabetes mellitus
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AbstractObjectiveTo determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy.MethodsThis retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012‐2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM diagnosis, categorized into medical and dietary management. The primary outcome was a composite including need for pharmacotherapy, large‐for‐gestational age, or neonatal hypoglycemia. Adjusted odds ratios (aOR) were calculated using multivariable logistic regression controlling for maternal age, pre‐pregnancy body mass index, and gestational age at GDM diagnosis in the index pregnancy.ResultsOf the 544 patients, 164 (30.1%) had prior GDM. Prior GDM significantly increased the likelihood of composite outcome compared to no prior GDM (74.4% vs. 57.4%; P < 0.001). After adjusting for confounders, prior GDM remained significantly associated with the composite outcome (aOR 2.03, 95% confidence interval [CI] 1.31–3.15). Stratifying by prior GDM treatment modality, a significant association was found for prior pharmacotherapy‐controlled GDM (aOR 3.29, 95% CI 1.64–6.59), but not for prior diet‐controlled GDM (aOR = 1.54, 95% CI 0.92–2.60).ConclusionA history of pharmacotherapy‐controlled GDM in a previous pregnancy increases odds of adverse perinatal outcomes in a subsequent GDM pregnancy.
