The Relationship Between Timing of Screening for Gestational Diabetes Mellitus and Maternal and Fetal Outcomes: A Retrospective Cohort Study Linking Primary Care Electronic and Hospital Administrative Data

Overview

Journal Obes Pillars

Date 2025 Feb 3

PMID 39896975

Authors

Helena Piccinini-Vallis

Mathew Grandy

Lynn Bussey

Jillian Coolen

Sarah Sabri

Affiliations

Soon will be listed here.

Abstract

Background: Gestational diabetes (GDM) is associated with adverse outcomes including a large-for-gestational age (LGA) baby, which in turn is associated with downstream childhood obesity. Appropriate timing of GDM screening is important for prompt initiation and optimization of medical management, potentially mitigating the risk of those outcomes. The present study explored the association between the timing of GDM screening and macrosomia, LGA, shoulder dystocia and caesarean section.

Methods: This retrospective cohort study linked primary care prenatal data and intrapartum data from a provincial hospital administrative database. Women with singleton pregnancies who received prenatal care between July 1, 2019 and December 31, 2022 and who also delivered within that timeframe were included in the study.

Results: 198 participants were linked between the databases. Among participants for whom GDM risk could be calculated (n = 180), 30.6 % had late GDM screening. Unadjusted logistic regression models showed that late screening for GDM was associated with higher likelihood of LGA (OR = 2.89; 95 % CI = 1.19-7.04; p = 00.019). Adjusted models showed that the best predictor of macrosomia, LGA, and shoulder dystocia was excess gestational weight gain (GWG) (OR = 3.26, CI = 1.17-9.10, p = 0.024; OR 3.00, 95 % CI 0.91-9.93, p = 00.072; and OR = 3.52, CI = 0.83-14.84, p = 00.087 respectively); the best predictor of caesarean section was pre-pregnancy BMI (OR = 2.86; CI = 1.12 = 7.27; p = 0.028).

Conclusions: Almost one-third of participants had screening later than recommended, and late screening for GDM was associated with a higher likelihood of LGA. Linking longitudinal prenatal primary care data to hospital administrative data creates opportunities for future studies pertaining to prenatal care, potentially resulting in improvements in the care provided to vulnerable populations experiencing disproportionate rates of pre-pregnancy obesity and excess GWG.

References

Tieu J, McPhee A, Crowther C, Middleton P, Shepherd E . Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst Rev. 2017; 8:CD007222. PMC: 6483271. DOI: 10.1002/14651858.CD007222.pub4. View

Najafi F, Hasani J, Izadi N, Hashemi-Nazari S, Namvar Z, Shamsi H . Risk of gestational diabetes mellitus by pre-pregnancy body mass index: A systematic review and meta-analysis. Diabetes Metab Syndr. 2021; 15(4):102181. DOI: 10.1016/j.dsx.2021.06.018. View

Palatnik A, Mele L, Landon M, Reddy U, Ramin S, Carpenter M . Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. Am J Obstet Gynecol. 2015; 213(4):560.e1-8. PMC: 4609640. DOI: 10.1016/j.ajog.2015.06.022. View

Simmons D, Immanuel J, Hague W, Teede H, Nolan C, Peek M . Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med. 2023; 388(23):2132-2144. DOI: 10.1056/NEJMoa2214956. View

Johns E, Denison F, Norman J, Reynolds R . Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab. 2018; 29(11):743-754. DOI: 10.1016/j.tem.2018.09.004. View

Voerman E, Santos S, Patro Golab B, Amiano P, Ballester F, Barros H . Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis. PLoS Med. 2019; 16(2):e1002744. PMC: 6370184. DOI: 10.1371/journal.pmed.1002744. View

Herman A, McCarthy B, Bakewell J, Ward R, Mueller B, Maconochie N . Data linkage methods used in maternally-linked birth and infant death surveillance data sets from the United States (Georgia, Missouri, Utah and Washington State), Israel, Norway, Scotland and Western Australia. Paediatr Perinat Epidemiol. 1997; 11 Suppl 1:5-22. DOI: 10.1046/j.1365-3016.11.s1.11.x. View

Cade T, Polyakov A, Brennecke S . Implications of the introduction of new criteria for the diagnosis of gestational diabetes: a health outcome and cost of care analysis. BMJ Open. 2019; 9(1):e023293. PMC: 6326329. DOI: 10.1136/bmjopen-2018-023293. View

Sacks D, Feig D . Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement?. Diabetologia. 2018; 61(5):1022-1026. DOI: 10.1007/s00125-018-4565-7. View

10.

Keely E, Berger H, Feig D . New Diabetes Canada Clinical Practice Guidelines for Diabetes and Pregnancy - What's Changed?. J Obstet Gynaecol Can. 2018; 40(11):1484-1489. DOI: 10.1016/j.jogc.2018.06.024. View

11.

Berger H, Gagnon R, Sermer M . Guideline No. 393-Diabetes in Pregnancy. J Obstet Gynaecol Can. 2019; 41(12):1814-1825.e1. DOI: 10.1016/j.jogc.2019.03.008. View

12.

Lavery J, Friedman A, Keyes K, Wright J, Ananth C . Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2016; 124(5):804-813. PMC: 5303559. DOI: 10.1111/1471-0528.14236. View

13.

Feig D, Berger H, Donovan L, Godbout A, Kader T, Keely E . Diabetes and Pregnancy. Can J Diabetes. 2018; 42 Suppl 1:S255-S282. DOI: 10.1016/j.jcjd.2017.10.038. View

14.

Feig D, Zinman B, Wang X, Hux J . Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008; 179(3):229-34. PMC: 2474881. DOI: 10.1503/cmaj.080012. View

15.

Williamson T, Green M, Birtwhistle R, Khan S, Garies S, Wong S . Validating the 8 CPCSSN case definitions for chronic disease surveillance in a primary care database of electronic health records. Ann Fam Med. 2014; 12(4):367-72. PMC: 4096475. DOI: 10.1370/afm.1644. View

16.

Hong Y, Lee J . Large for Gestational Age and Obesity-Related Comorbidities. J Obes Metab Syndr. 2021; 30(2):124-131. PMC: 8277589. DOI: 10.7570/jomes20130. View

17.

Brown C, Perrin E . Obesity Prevention and Treatment in Primary Care. Acad Pediatr. 2018; 18(7):736-745. DOI: 10.1016/j.acap.2018.05.004. View

18.

Wharton S, Lau D, Vallis M, Sharma A, Biertho L, Campbell-Scherer D . Obesity in adults: a clinical practice guideline. CMAJ. 2020; 192(31):E875-E891. PMC: 7828878. DOI: 10.1503/cmaj.191707. View

19.

Ryan D, Haddow L, Ramaesh A, Kelly R, Johns E, Denison F . Early screening and treatment of gestational diabetes in high-risk women improves maternal and neonatal outcomes: A retrospective clinical audit. Diabetes Res Clin Pract. 2018; 144:294-301. DOI: 10.1016/j.diabres.2018.09.013. View

20.

Bartakova V, tapalova V, Wagnerova K, Janku P, Belobradkova J, Kankova K . [Pregnancy outcomes in women with gestational diabetes: specific subgroups might require increased attention]. Ceska Gynekol. 2017; 82(1):16-23. View