1
|
Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2022; 377:e067946. [PMID: 35613728 PMCID: PMC9131781 DOI: 10.1136/bmj-2021-067946] [Citation(s) in RCA: 175] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between gestational diabetes mellitus and adverse outcomes of pregnancy after adjustment for at least minimal confounding factors. DESIGN Systematic review and meta-analysis. DATA SOURCES Web of Science, PubMed, Medline, and Cochrane Database of Systematic Reviews, from 1 January 1990 to 1 November 2021. REVIEW METHODS Cohort studies and control arms of trials reporting complications of pregnancy in women with gestational diabetes mellitus were eligible for inclusion. Based on the use of insulin, studies were divided into three subgroups: no insulin use (patients never used insulin during the course of the disease), insulin use (different proportions of patients were treated with insulin), and insulin use not reported. Subgroup analyses were performed based on the status of the country (developed or developing), quality of the study, diagnostic criteria, and screening method. Meta-regression models were applied based on the proportion of patients who had received insulin. RESULTS 156 studies with 7 506 061 pregnancies were included, and 50 (32.1%) showed a low or medium risk of bias. In studies with no insulin use, when adjusted for confounders, women with gestational diabetes mellitus had increased odds of caesarean section (odds ratio 1.16, 95% confidence interval 1.03 to 1.32), preterm delivery (1.51, 1.26 to 1.80), low one minute Apgar score (1.43, 1.01 to 2.03), macrosomia (1.70, 1.23 to 2.36), and infant born large for gestational age (1.57, 1.25 to 1.97). In studies with insulin use, when adjusted for confounders, the odds of having an infant large for gestational age (odds ratio 1.61, 1.09 to 2.37), or with respiratory distress syndrome (1.57, 1.19 to 2.08) or neonatal jaundice (1.28, 1.02 to 1.62), or requiring admission to the neonatal intensive care unit (2.29, 1.59 to 3.31), were higher in women with gestational diabetes mellitus than in those without diabetes. No clear evidence was found for differences in the odds of instrumental delivery, shoulder dystocia, postpartum haemorrhage, stillbirth, neonatal death, low five minute Apgar score, low birth weight, and small for gestational age between women with and without gestational diabetes mellitus after adjusting for confounders. Country status, adjustment for body mass index, and screening methods significantly contributed to heterogeneity between studies for several adverse outcomes of pregnancy. CONCLUSIONS When adjusted for confounders, gestational diabetes mellitus was significantly associated with pregnancy complications. The findings contribute to a more comprehensive understanding of the adverse outcomes of pregnancy related to gestational diabetes mellitus. Future primary studies should routinely consider adjusting for a more complete set of prognostic factors. REVIEW REGISTRATION PROSPERO CRD42021265837.
Collapse
Affiliation(s)
- Wenrui Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Huang
- National Clinical Research Centre for Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenglong Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Fangkun Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypothalamic Pituitary Research Centre, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
2
|
Farina A, Eklund E, Bernabini D, Paladino M, Righetti F, Monti G, Lambert-Messerlian G. A First-Trimester Biomarker Panel for Predicting the Development of Gestational Diabetes. Reprod Sci 2016; 24:954-959. [DOI: 10.1177/1933719116675057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Antonio Farina
- Division of Prenatal Medicine, Department of Medicine and Surgery (DIMEC), University of Bologna, Bologna, Italy
| | - Elizabeth Eklund
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| | - Dalila Bernabini
- Division of Prenatal Medicine, Department of Medicine and Surgery (DIMEC), University of Bologna, Bologna, Italy
| | - Mariangela Paladino
- Division of Laboratory Medicine, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Francesca Righetti
- Division of Laboratory Medicine, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Giuseppe Monti
- Division of Laboratory Medicine, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Geralyn Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, USA
| |
Collapse
|
3
|
Abstract
OBJECTIVE To examine impact on perinatal outcome of untreated gestational diabetes (GDM) and non-diabetics stratified by body mass index (BMI). RESEARCH DESIGN AND METHODS This is a secondary analysis of our investigation of the consequences of not treating GDM. We evaluated 555 untreated GDMs matched to 1100 non-diabetics. BMI was determined using subjects' recalled pre-pregnancy weight. A primary composite variable consisted of stillbirth, neonatal macrosomia/large-for-gestational-age (LGA), neonatal hypoglycemia, erythrocytosis and hyperbilirubinemia. Secondary outcomes included shoulder dystocia, respiratory complications, cesarean delivery and pregnancy-related hypertension. RESULTS Untreated subjects in the normal weight category had an ∼2-fold increase for composite outcome and LGA and a 7-fold increase in metabolic complications. The overweight untreated group showed composite outcome, LGA and metabolic complications 2-3-fold higher and induction of labor 5-fold higher. For obese untreated GDMs, significantly higher rates of composite outcome, LGA and metabolic complications, induction of labor and cesarean delivery were 10-, 3-, 5-, 4- and 9-fold, respectively. Perinatal outcome for normal weight untreated GDM was similar to obese non-diabetics. CONCLUSIONS Maternal obesity and GDM independently affect adverse pregnancy outcome. The combination has a greater impact than each one alone. However, glycemic level contributes a greater portion to the adverse pregnancy equation.
Collapse
|
4
|
Maged AM, Moety GAF, Mostafa WA, Hamed DA. Comparative study between different biomarkers for early prediction of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2013; 27:1108-12. [PMID: 24090161 DOI: 10.3109/14767058.2013.850489] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study various biomarkers in prediction of gestational diabetes mellitus (GDM). PATIENTS AND METHODS Prospective observational study included 400 pregnant women. Maternal serum sex hormone binding globulin (SHBG), high-sensitive C-reactive protein (hs-CRP), uric acid, creatinine and albumin were measured before 15 weeks of gestation. Patients were followed-up for development of GDM. RESULTS A total of 269 women were eligible for analysis. GDM complicated 27 (10.03%) of pregnancies. Hs-CRP levels were significantly higher and SHBG levels were significantly lower among women who subsequently developed GDM compared with normoglycemics. Uric acid, albumin and creatinine levels were not significantly different between both groups. For prediction of GDM, hs-CRP at a cutoff value of 2.55 mg/l showed a sensitivity and a specificity of 89% and 55%, respectively. SHBG at a cutoff value of 211.5 nmol/l showed a sensitivity and a specificity of 85% and 37%, respectively. Low SHBG with high hs-CRP predicted GDM with a sensitivity and specificity of 74.07% and 75.62%, respectively with an overall accuracy of 75.46%. CONCLUSION Hs-CRP and SHBG are important early predictors of GDM. Adding SHBG to hs-CRP improves specificity and serves good overall accuracy. Uric acid, creatinine and albumin have no role in GDM prediction.
Collapse
|
5
|
Vellinga A, Zawiejska A, Harreiter J, Buckley B, Di Cianni G, Lapolla A, Corcoy R, Simmons D, Adelantado JM, Damm P, Desoye G, Devlieger R, Hill D, Kautzky-Willer A, Klemetti M, Mathiesen E, Rebollo P, Snoek F, Tikkanen M, Timmerman D, van Assche A, van Poppel M, Wender-Oegowska E, Dunne F. Associations of Body Mass Index (Maternal BMI) and Gestational Diabetes Mellitus with Neonatal and Maternal Pregnancy Outcomes in a Multicentre European Database (Diabetes and Pregnancy Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention). ISRN OBESITY 2012; 2012:424010. [PMID: 24527262 PMCID: PMC3914269 DOI: 10.5402/2012/424010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/04/2012] [Indexed: 11/23/2022]
Abstract
Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and maternal pregnancy outcomes. Methods. Cross-sectional data (3343 pregnancies) from seven European centres were included in a multilevel analysis of the association between GDM/obesity and caesarean section, macrosomia and neonatal morbidities. Results. Comparison of databases identified reporting differences between countries due to the inclusion of true population based samples or pregnancies from specialised tertiary centres, resulting in higher prevalences of GDM for some countries. The analysis showed that obesity and GDM were independent risk factors of perinatal complications. Only BMI had a dose-dependent effect on the risk of macrosomia and caesarean section. Both obesity (BMI > 30 kg/m2) and GDM were independent risk factors of neonatal morbidities. Conclusions. Obesity and GDM were independent risk factors of perinatal complications. The effect of the worldwide obesity and diabetes epidemic is extending to the next generation.
Collapse
Affiliation(s)
- Akke Vellinga
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - A Zawiejska
- Akademia Medyczna im Karola Marcinkowskiego, 60-512 Poznan, Poland
| | - J Harreiter
- Department of Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - B Buckley
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - G Di Cianni
- Dipartimento di Endocrinologia e Malattie del Metabolismo, Università di Pisa, 56126 Pisa, Italy
| | - A Lapolla
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Padova, 35122 Padova, Italy
| | - R Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - D Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - J M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - P Damm
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - G Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
| | - R Devlieger
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - D Hill
- Recherche en Sante Lawson, 9552 Bronschhofen, Switzerland
| | - A Kautzky-Willer
- Department of Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - M Klemetti
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - E Mathiesen
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - P Rebollo
- BAP Health Outcomes Research, S.L, 33010 Oviedo, Spain
| | - F Snoek
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center Amsterdam, 1007 MB Amsterdam, The Netherlands
| | - M Tikkanen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - D Timmerman
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - A van Assche
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - M van Poppel
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center Amsterdam, 1007 MB Amsterdam, The Netherlands
| | | | - F Dunne
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
| |
Collapse
|
6
|
Meta-Analysis of Maternal and Neonatal Outcomes Associated with the Use of Insulin Glargine versus NPH Insulin during Pregnancy. Obstet Gynecol Int 2012; 2012:649070. [PMID: 22685467 PMCID: PMC3362948 DOI: 10.1155/2012/649070] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/28/2012] [Accepted: 02/06/2012] [Indexed: 11/22/2022] Open
Abstract
As glargine, an analog of human insulin, is increasingly used during pregnancy, a meta-analysis assessed its safety in this population. A systematic literature search identified studies of gestational or pregestational diabetes comparing use of insulin glargine with human NPH insulin, with at least 15 women in both arms. Data was extracted for maternal outcomes (weight at delivery, weight gain, 1st/3rd trimester HbA1c, severe hypoglycemia, gestation/new-onset hypertension, preeclampsia, and cesarean section) and neonatal outcomes (congenital malformations, gestational age at delivery, birth weight, macrosomia, LGA, 5 minute Apgar score >7, NICU admissions, respiratory distress syndrome, neonatal hypoglycemia, and hyperbilirubinemia). Relative risk ratios and weighted mean differences were determined using a random effect model. Eight studies of women using glargine (331) or NPH (371) were analyzed. No significant differences in the efficacy and safety-related outcomes were found between glargine and NPH use during pregnancy.
Collapse
|
7
|
Driggers RW, Baschat A. The 12th meeting of the Diabetes in Pregnancy Study Group of North America (DPSG-NA): introduction and overview. J Matern Fetal Neonatal Med 2011; 25:3-4. [PMID: 21954980 DOI: 10.3109/14767058.2012.626917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Diabetes in Pregnancy Study Group of North America (DPSG-NA) held its 12th meeting April 1-2, 2011 in Washington DC. The meeting, which was co-hosted by the Washington Hospital Center and the University of Maryland School of Medicine focused on five broad themes: (i) the prevention of diabetes and its risk factors, such as obesity, in pregnancy; (ii) the appropriate use of pharmacotherapies for managing diabetes in pregnancy; (iii) optimal glycemic control; (iv) the value of nutrition, exercise and limiting weight gain during pregnancy and (v) the diagnosis and consequences of diabetic fetopathy. These proceedings reflect peer-reviewed papers of data presented at the meeting. Time also was allocated to discuss the perceived barriers to using the one-step, 75 g oral glucose tolerance test as the first-line approach to diagnosing gestational diabetes mellitus. Responses from a survey of participants on perceived barriers to adopting this method into widespread clinical practice are discussed.
Collapse
|
8
|
Wong SF, Petersen SG, Idris N, Thomae M, McIntyre HD. Ductus venosus velocimetry in monitoring pregnancy in women with pregestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:350-354. [PMID: 20617505 DOI: 10.1002/uog.7744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this research was to assess the ability of ductus venosus (DV) Doppler velocimetry to predict adverse perinatal outcome in pregnancies complicated by pre-existing diabetes mellitus. METHODS This was a prospective study conducted at a tertiary referral obstetric facility in Brisbane, Australia. The study group included women with pregestational diabetes mellitus who delivered in the hospital between 1 January 1995 and 31 December 2006. The DV Doppler index was defined as abnormal if the DV peak velocity index for veins (PVIV) was equal to or greater than the 95(th) percentile for gestation. Adverse perinatal outcome included one or more of the following criteria: small-for-gestational-age infant; Cesarean section for non-reassuring fetal status; fetal acidemia at delivery; a 1-min Apgar score of <or= 3; a 5-min Apgar score of < 7; hypoxic ischemic encephalopathy; and stillbirth or neonatal death. The maternal characteristics and perinatal outcomes of pregnancies with normal or abnormal DV Doppler indices were compared. RESULTS Eighty-two pregestational diabetic pregnancies were studied and an abnormal DV-PVIV was identified in 25 (30.5%). Adverse perinatal outcome was identified in eight of 25 (32.0%) pregnancies with an abnormal DV-PVIV compared to seven of 57 (12.3%) pregnancies with a normal DV-PVIV (P < 0.05). The sensitivity of the DV-PVIV in predicting adverse perinatal outcomes in pregestational diabetic pregnancies was 53.3%, the specificity was 74.6%, the positive predictive value was 32.0% and the negative predictive value was 87.7%. CONCLUSION It may be useful to include DV-PVIV in the antenatal screening of pregnancies complicated by pregestational diabetes.
Collapse
Affiliation(s)
- S F Wong
- Department of Maternal Fetal Medicine, University of Queensland, Mater Mothers' Hospital, South Brisbane, QLD, Australia.
| | | | | | | | | |
Collapse
|
9
|
Reece EA. The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2010; 23:199-203. [PMID: 20121460 DOI: 10.3109/14767050903550659] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Gestational diabetes mellitus (GDM) is a type of diabetes that presents during pregnancy and usually disappears shortly after a woman gives birth. Better recognition of the risk factors of GDM, combined with more universal screening for the disease in many countries, has led to the increased detection of GDM along with other forms of pregestational diabetes. There is growing evidence that GDM significantly increases the risk of a number of short- and long-term adverse consequences for the fetus and mother, the most significant of which is a predisposition to the development of metabolic syndrome and Type 2 diabetes. Maternal and childhood obesity as well as cardiovascular disease are also potential long-term consequences of GDM. On the other hand, there is a growing body of evidence suggesting that the risk of many of these consequences can be significantly reduced or eliminated by aggressive treatment of GDM. There remains, however, a great deal of controversy over when to begin screening for hyperglycemia in pregnancy and at what level of hyperglycemia should aggressive intervention be initiated.
Collapse
Affiliation(s)
- E Albert Reece
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Room 14-029, Baltimore, MD 21201-1559, USA.
| |
Collapse
|
10
|
Wendland EM, Pinto ME, Duncan BB, Belizán JM, Schmidt MI. Cigarette smoking and risk of gestational diabetes: a systematic review of observational studies. BMC Pregnancy Childbirth 2008; 8:53. [PMID: 19077324 PMCID: PMC2632653 DOI: 10.1186/1471-2393-8-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 12/16/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes is a prevalent disease associated with adverse outcomes of pregnancy. Smoking as been associated with glucose intolerance during pregnancy in some but not all studies. Therefore, we aimed to systematically review all epidemiological evidence to examine the association between cigarette smoking during pregnancy and risk of developing gestational diabetes mellitus. METHODS We conducted a systematic review of articles published up to 2007, using PubMed, Embase, LILACS e CINAHL to identify the articles. Because this review focuses on studies of smoking during pregnancy, we excluded studies evaluating smoking outside pregnancy. Two investigators independently abstracted information on participant's characteristics, assessment of exposure and outcome, and estimates for the association under study. We evaluated the studies for publication bias and performed heterogeneity analyses. We also assessed the effect of each study individually through sensitivity analysis. RESULTS We found and critically reviewed 32 studies, of which 12 met the criteria for inclusion in the review. Most of the studies provided only unadjusted measurements. Combining the results of the individual studies, we obtained a crude odds ratio of 1.03 (99% CI 0.85-1.25). Only 4 studies presented adjusted measurements of association, and no association was found when these alone were analyzed (OR 0.95; 99% CI 0.85-1.07). Subgroup analysis could not be done due to small sample size. CONCLUSION The number of studies is small, with major heterogeneity in research design and findings. Taken together, current data do not support an association between cigarette smoking during pregnancy and the risk of gestational diabetes.
Collapse
Affiliation(s)
- Eliana M Wendland
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Eugênia Pinto
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José M Belizán
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Inês Schmidt
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
11
|
Abstract
The number of people worldwide who are obese and diabetic has increased in all age and ethnic groups. Obesity and diabetes have implications for all aspects of maternal/fetal health and outcome during pregnancy with short and long-term ramifications. Liberal pharmacological therapy, relative weight gain restriction in comparison to non-obese diabetic women, improved lifestyle changes, and achievement of targeted levels of glycemic control can mitigate pregnancy complications and result in improved pregnancy outcome.
Collapse
|
12
|
|
13
|
Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during pregnancy in South Australia. Aust N Z J Obstet Gynaecol 2003; 43:421-8. [PMID: 14712944 DOI: 10.1046/j.0004-8666.2003.00120.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify risk factors for hypertension in pregnancy among South Australian women. DESIGN A population-based retrospective analysis using the South Australian perinatal data collection for 1998-2001. METHODS Three groups of women with hypertension (pre-existing hypertension, pregnancy hypertension, and superimposed pre-eclampsia) were compared with normotensive women using unconditional logistic regression analysis on 70,386 singleton births to identify sociodemographic and clinical risk factors for hypertension in pregnancy. RESULTS Nulliparity, Aboriginal race and Caucasian race (compared with Asian) and pre-existing and gestational diabetes were demonstrated to be risk factors for all hypertensive disorders, as was increasing maternal age for pre-existing hypertension and superimposed pre-eclampsia. Risk was increased for pregnancy hypertension and superimposed pre-eclampsia among women who gave their occupation as 'home duties' and also for superimposed pre-eclampsia among unemployed women. Women with hypertension were more likely to give birth in teaching hospitals. Urinary tract infections were not found to be a risk factor for any type of hypertension. Smoking during pregnancy was protective for all types of hypertension. CONCLUSIONS The present study used a statewide population perinatal database and has confirmed that Aboriginal race, Caucasians, nulliparity, and pre-existing and gestational diabetes are independent risk factors for all types of hypertension in pregnancy. Increasing maternal age increased the risk for pre-existing hypertension and superimposed pre-eclampsia. There appeared to be appropriate referral of women with hypertensive disorders to teaching hospitals. A new finding is the increased risk among unemployed women and women engaged in home duties.
Collapse
Affiliation(s)
- Daniëlle J Jacobs
- Department of Obstetrics and Gynaecology, University of Adelaide, Lyell McEwin Health Service, Adelaide, South Australia, Australia
| | | | | | | | | | | |
Collapse
|
14
|
Wong SF, Chan FY, Cincotta RB, McIntyre DH, Stone M. Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre-existing diabetes. Aust N Z J Obstet Gynaecol 2003; 43:302-6. [PMID: 14714716 DOI: 10.1046/j.0004-8666.2003.00094.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The usefulness of umbilical artery Doppler velocimetry for the monitoring of diabetic pregnancies is controversial. The aim of the present study was to assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated by pre-existing diabetes mellitus. METHODS All diabetic pregnancies (type 1 and 2) delivered at Mater Mothers' Hospital, Queensland, between 1 January 1995 and 31 December 1999 were included. All pregnant diabetic women were monitored with umbilical artery Doppler velocimetry at 28, 32, 36, and 38 weeks' gestation. Adverse perinatal outcome was defined as pregnancies with one or more of the following: small-for-gestational age, Caesarean section for non-reassuring cardiotocography, fetal acidaemia at delivery, 1-min Apgar of 3 or less, 5-min Apgar of less than 7, hypoxic ischaemic encephalopathy or perinatal death. Abnormal umbilical artery Doppler velocimetry was defined as a pulsatility index of 95th centile or higher for gestation. RESULTS One hundred and four pregnancies in women with pre-existing diabetes had umbilical arterial Doppler studies carried out during the study period. Twenty-three pregnancies (22.1%) had an elevated pulsatility index. If the scans were carried out within 2 weeks of delivery, 71% of pregnancies with abnormal umbilical Doppler had adverse outcomes (P < 0.01; likelihood ratio, 4.2). However, the sensitivity was 35%; specificity was 94%; positive predictive value was 80%; and negative predictive value was 68%. Only 30% of women with adverse perinatal outcomes had abnormal umbilical arterial Doppler flow. CONCLUSION Umbilical artery Doppler velocimetry is not a good predictor of adverse perinatal outcomes in diabetic pregnancies.
Collapse
Affiliation(s)
- Shell Fean Wong
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Australia.
| | | | | | | | | |
Collapse
|