Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
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Teresa A. Hillier
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Kathryn L. Pedula
Abstract
Objectives
Gestational diabetes (GDM) screening at 24–28 weeks’ gestation reduces risk of adverse maternal and perinatal outcomes. While experts recommend first-trimester screening for high-risk patients, including those with obesity, data supporting this recommendation is limited.
Methods
We implemented a systematic population intervention to encourage first-trimester GDM screening by oral glucose tolerance testing in a cohort of pregnant people with obesity in two integrated health systems from 2009 to 2013, and compared outcomes to the same population pre-intervention (2006–2009). Up to five years of postpartum glucose testing results (through 2018) were assessed among GDM cases in the post-intervention group. Primary outcomes were large-for-gestational-age birthweight (LGA); macrosomia; a perinatal composite outcome; gestational hypertension/preeclampsia; cesarean delivery; and medication treatment of GDM.
Results
A total of 40,206 patients (9,156 with obesity) were screened for GDM; 2,672 (6.6%) were diagnosed with GDM. Overall, multivariate adjusted risk for LGA and cesarean delivery were lower following the intervention (LGA: aOR 0.89 [0.82, 0.96]; cesarean delivery: 0.89 [0.85, 0.93]). This difference was more pronounced in patients diagnosed with GDM (LGA: aOR 0.52 [0.39, 0.70]; cesarean delivery 0.78 [0.65, 0.94]); insulin/oral hypoglycemic treatment rates for GDM were also higher post-intervention than pre-intervention (22 vs. 29%; p<0.0001). There were no differences for the other primary outcomes. Only 20% of patients diagnosed with GDM early in pregnancy who had postpartum testing had results in the overt diabetes range, suggesting a spectrum of diabetes detected early in pregnancy.
Conclusions
First trimester GDM screening for pregnant people with obesity may improve GDM-associated outcomes.
Award Identifier / Grant number: 1R01HD058015
Acknowledgments
We thank Neon Brooks, PhD for editorial support and Robin Daily for administrative support.
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Research funding: This work was supported by grant award 1R01HD058015 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (to TH). Neither the funding source nor the authors’ institutions had any involvement in the study design; the collection, analysis or interpretation of data; the writing of the report; or in the decision to submit the article for publication.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: Research involving human subjects complied with all relevant national regulations and institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013). Institutional Review Boards (IRBs) at both institutions approved the early screening intervention and evaluation as part of clinical care as the practice is clinically recommended for patients with obesity. The Kaiser Permanente Northwest IRB approved the study January 16, 2008 and the Kaiser Permanente Hawaii IRB approved the study March 20, 2009. Both IRBs approved waivers for individual consent with their study approval as the intervention was minimal risk, clinically recommended, and conducted as part of clinical care.
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© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
Artikel in diesem Heft
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
