Association of types of diabetes and insulin dependency on birth outcomes

Update on gestational diabetes and adverse pregnancy outcomes

PURPOSE OF REVIEW

To explore the recent literature concerning the effect of gestational diabetes (GDM) on adverse pregnancy outcomes (APO).

RECENT FINDINGS

Literature search on PubMed, Medline and British Journal of Obstetrics and Gynaecology was conducted using keywords. Search fields were filtered down to include articles from 2019 onwards. GDM is common during pregnancy and is on the rise because of increasing in obesity rates. GDM tended to show an increased risk of APO compared with non-GDM. Treatment of these pregnancies tended to improve these outcomes, particularly for LGA and macrosomia. Additional factors such as prepregnancy BMI and gestational weight gain (GWG) were shown to influence risk. More studies are needed to determine the true effect on postpartum haemorrhage (PPH) and induction of labour (IOL).

SUMMARY

The review agrees with the findings from previous studies and adds to the current literature. Early intervention to manage glycaemic control and GWG may help improve these outcomes. Public health strategies that tackle obesity rates will help to reduce prepregnancy BMI and, therefore, rates of GDM.

Are pregnancy-associated hypertensive disorders so sweet?

Worldwide, one in seven pregnancies is complicated by some form of diabetes, with a rising trend. Additionally, hypertension is one of the main causes of morbidity and mortality for both the pregnant woman and the fetus and also contributes to premature birth. In a cohort study of pregnant women with diabetes, which was recently published in this journal, at least 84.5% of the subjects had hypertension. This rate of hypertension might be among the highest reported thus far. In the medical literature, approximately 20% of women with diabetes during pregnancy have various pregnancy-associated hypertensive disorders. Racial/ethnic differences, apparently, were not implicated in this elevated rate of hypertension: Although black and Hispanic women have a twofold higher rate of hypertension in pregnancy compared to white women, 75% of the subjects in the study in question were white. Thus, the impressive finding delivered by this large study, merits additional clarifications.