Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study

Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus

To evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34–5.40) and 3.92 (95% CI 3.65–4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63–3.33) and 1.90 (95% CI 1.76–2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56–7.75) and 5.81 (95% CI 5.15–6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.

Metformin versus insulin use for treatment of gestational diabetes and delivery by caesarean section: A nationwide Swedish cohort study

OBJECTIVE

Pregnant women who develop gestational diabetes (GDM) are more likely to deliver by caesarean section (CS). Over the last decade, the use of metformin has increased as an alternative to insulin but it's unknown how this shift in treatment has influenced the mode of delivery. Therefore, the aim of this study was to determine the association between metformin use and CS and delivery of a large-for-gestational age (LGA) infant compared to insulin use for GDM.

STUDY DESIGN

The Swedish population health registers were linked to identify pregnant women from 2012 to 2016 without preexisting diabetes and with a first filled prescription of insulin or metformin in trimester 2 or 3 (n = 2467), categorized into those treated with insulin only (88%), metformin only (7.6%), or both insulin and metformin (4.3%). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Analyses were adjusted for relevant covariates and stratified by history of CS.

RESULTS

The proportion of women using metformin to treat GDM increased from 2.5% in 2012 to over 30% in 2016. Comparing insulin only to metformin only use, no association with delivery by CS (adjusted OR 0.79, 95% CI; 0.54-1.16) and lower odds of delivering a LGA infant (adjusted OR 0.44, 95% CI; 0.26-0.76) was found. Treatment with both insulin and metformin was associated with an increased risk of CS (adjusted OR 1.65, 95% CI; 1.06-2.56), which were more often unplanned. Estimates were further elevated in nulliparous (adjusted OR 2.32, 95% CI; 0.95-5.65) and multiparous women with a history of CS (adjusted OR 2.29, 95% CI; 0.60-8.74) but conclusions could not be drawn given the wide CIs.

CONCLUSION

There was no evidence of a higher association of metformin use alone with CS compared to insulin use for treatment of GDM but a protective effect for delivery of a LGA infant was shown. Women requiring treatment with both insulin and metformin had increased odds for delivery by CS which in turn may indicate that the need for the use of both medications to treat GDM suggests a pregnancy at higher risk.