Looking beyond the first: recurrent gestational diabetes mellitus and its associated obstetric and neonatal complications   — ASN Events
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  3. Looking beyond the first: recurrent gestational diabetes mellitus and its associated obstetric and neonatal complications  

Looking beyond the first: recurrent gestational diabetes mellitus and its associated obstetric and neonatal complications   (#138)

Ning NZ Zhang 1 2 , Chih Ying (Maggie) CYK Ko 1 2 , Jenny JW Wright 1 , Stephanie ST Terry 1 , Robyn RB Barnes 1 , Cunjing CL Li 1 , Androulla AG Georgious 1 , Mikey MX Xie 1 2 , Sarah SA Abdo 1 3 , Jeff JF Flack 1 3 , Tang TW Wong 1 2 3
  1. Diabetes Centre, Bankstown-Lidcombe Hospital, SWSLHD , Bankstown
  2. Faculty of Medicine and Health, University of New South Wales, Sydney
  3. School of Medicine, Western Sydney University, Sydney

Background 

Recurrence of gestational diabetes mellitus (GDM) in subsequent pregnancies is well-established, with reported rates up to 75% in high-risk cohorts (1). However, the clinical trajectory of recurrent GDM remains poorly characterised with potentially compounding risks of adverse maternal and neonatal outcomes in subsequent pregnancies.  

Aim 

To compare pregnancy outcomes and postpartum oral glucose tolerance test (OGTT) results in women with recurrent GDM across their first, second and third pregnancies.  

Methods 

We analysed de-identified prospectively collected singleton pregnancy data (1991 – 2025) from women with three GDM-affected pregnancies at Bankstown-Lidcombe Hospital. Pregnancy outcomes included maximum insulin dose, insulin use, excess gestational weight gain (eGWG), caesarean section, early delivery, large for gestational age (LGA), small for gestational age (SGA), neonatal hypoglycaemia, neonatal jaundice and shoulder dystocia. eGWG was defined according to the National Academy of Medicine (NAM) weight gain targets. LGA and SGA were defined >90th and <10th centiles respectively, using a customised centile calculator. Paired samples t-tests and McNemar’s test were used to assess statistical significance for continuous and categorical data respectively over subsequent pregnancies. Odds ratios were calculated from 2x2 contingency tables.  

Results 

There were 196 women with three GDM-affected pregnancies. Maximum total insulin dose increased significantly with each pregnancy from a mean of 36.48 units at the index pregnancy to 56.22 units at the third pregnancy (P <0.001). Caesarean section rates increased progressively, with significantly higher rates at the third compared to both the second (OR 5.0, 95%CI1.7-14.6, P<0.01) and index pregnancy (OR 4.1, 95%CI1.8-9.4, P<0.001). LGA and neonatal hypoglycaemia (NH) rates increased in subsequent pregnancies, with significantly higher rates at the third compared to the index pregnancy (LGA: OR 2.5, 95%CI1.2-4.9, P<0.05 and NH: OR 3.5, 95%CI1.4-8.7, P<0.01).  

Conclusion 

Recurrent GDM is associated with increased rates of caesarean section, LGA and neonatal hypoglycaemia in subsequent pregnancies. Further research is needed for targeted intervention in this high-risk population to reduce the burden of recurrent GDM and its associated complications in subsequent pregnancies. 

References 

  1. Wong et al (2019). Factors predicting recurrence of gestational diabetes in a high‐risk multi‐ethnic population. Australian and New Zealand Journal of Obstetrics and Gynaecology.