Delayed diagnosis of gestational diabetes mellitus and perinatal outcomes in women with large for gestational age fetuses during the third trimester
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ObjectiveWe evaluated the incidence of newly diagnosed gestational diabetes mellitus (GDM) during the 3rd trimester inwomen with suspected large for gestational age (LGA) fetuses on ultrasound and assessed their perinatal outcomes. MethodsA retrospective cohort study was performed. Singleton pregnant women with suspected LGA on the 3rd trimesterultrasound and whose results of GDM screening at midpregnancy had been normal were enrolled. All participantswere retested with 100-g oral glucose tolerance test (OGTT) within 2 days after diagnosis of LGA. We comparedperinatal outcomes between the newly diagnosed with GDM group and the non-GDM group. ResultsAmong 169 pregnant women, 13% (23/169) were newly diagnosed with GDM. The women in the GDM group hada higher HbA1c level at diagnosis (5.8 vs. 5.3, P<0.01) and earlier gestational age at delivery (38.0 vs 38.9 weeks ofgestation, P=0.003) than those in the non-GDM group. The rate of cesarean delivery (CD) was significantly higherin the GDM group than that in the non-GDM group (73.9%, vs. 49.3%, P=0.028) with similar proportions for theindications of CD except CD on maternal request (CDMR). The CDMR rate was higher in the GDM group than non-GDM group (41.2% vs. 23.6%) but it did not reach statistical significance. There were no significant differences in theobstetrical and neonatal complications between the two groups. ConclusionAmong pregnant women with suspected LGA, 13% were newly diagnosed with GDM in late pregnancy. Nonetheless,there were no differences in the perinatal outcomes between women with newly diagnosed GDM and those withoutGDM. However, concerns over shoulder dystocia appear to increase CD rates in the GDM group.
Abstract
ObjectiveWe evaluated the incidence of newly diagnosed gestational diabetes mellitus (GDM) during the 3rd trimester inwomen with suspected large for gestational age (LGA) fetuses on ultrasound and assessed their perinatal outcomes. MethodsA retrospective cohort study was performed. Singleton pregnant women with suspected LGA on the 3rd trimesterultrasound and whose results of GDM screening at midpregnancy had been normal were enrolled. All participantswere retested with 100-g oral glucose tolerance test (OGTT) within 2 days after diagnosis of LGA. We comparedperinatal outcomes between the newly diagnosed with GDM group and the non-GDM group. ResultsAmong 169 pregnant women, 13% (23/169) were newly diagnosed with GDM. The women in the GDM group hada higher HbA1c level at diagnosis (5.8 vs. 5.3, P<0.01) and earlier gestational age at delivery (38.0 vs 38.9 weeks ofgestation, P=0.003) than those in the non-GDM group. The rate of cesarean delivery (CD) was significantly higherin the GDM group than that in the non-GDM group (73.9%, vs. 49.3%, P=0.028) with similar proportions for theindications of CD except CD on maternal request (CDMR). The CDMR rate was higher in the GDM group than non-GDM group (41.2% vs. 23.6%) but it did not reach statistical significance. There were no significant differences in theobstetrical and neonatal complications between the two groups. ConclusionAmong pregnant women with suspected LGA, 13% were newly diagnosed with GDM in late pregnancy. Nonetheless,there were no differences in the perinatal outcomes between women with newly diagnosed GDM and those withoutGDM. However, concerns over shoulder dystocia appear to increase CD rates in the GDM group.
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