Is there a residual risk of large-for-gestational-age infant related to gestational diabetes mellitus when it is treated? - 28/07/22

Doi : 10.1016/j.diabet.2022.101376

Emmanuel Cosson ^1,^2,^⁎ , Eric Vicaut ³, Sopio Tatulashvili ^1,², Jean-Jacques Portal ³, Charlotte Nachtergaele ³, Meriem Sal ¹, Narimane Berkane ¹, Sara Pinto ⁴, Amel Rezgani ¹, Lionel Carbillon ^5,⁶, Hélène Bihan ¹
¹ AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
² Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
³ AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, Paris, France
⁴ AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
⁵ AP-HP, Avicenne and Jean Verdier Hospitals, Paris 13 University, Sorbonne Paris Cité, Biochemistry Department, Bobigny, France
⁶ AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Obstetrics and Gynecology, Bondy, France

^⁎Corresponding author:

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Abstract

Objective

The hyperglycaemia and adverse pregnancy outcomes (HAPO) study, where hyperglycaemia was untreated, showed a continuous association between large-for-gestational-age (LGA) infant and seven increasing categories of fasting plasma glucose (PG), 1-hour and 2-hour PG values after a 75g oral glucose tolerance test at 24-32 gestational weeks. We evaluated whether the excess risk persisted in the 6th and 7th glucose categories - corresponding to women treated for gestational diabetes mellitus (GDM).

Patients and methods

We included 7,190 women meeting the HAPO criteria, of whom 655 (9.2%) were treated for GDM (dietary education in all; insulin therapy in 150 (20.3%)). We evaluated the adjusted odds ratio (aOR) for each glucose category (reference 1^st category) for LGA infant.

Results

The aOR for LGA linearly increased from the 1^st to 5^th categories of fasting, 1-hour and 2-hour PG. Specifically, the aORs for the 5^th category were 2.20 (95% confidence interval 1.41-3.44), 2.25 (1.11-4.59), and 2.51 (1.63-3.85), respectively. The aORs for the 6^th category were globally stable at 2.52 (1.46-4.36), 2.87 (1.48-5.54), and 2.47 (1.46-4.16), respectively. The same was true for the 7^th category: 1.41 (0.56-3.55), 2.84 (1.03–7.86), and 3.53 (1.77-7.06), respectively.

Conclusion

We confirmed the association between increasing PG category and LGA infant in women without GDM. We did not observe a residual risk of LGA infant in women treated for GDM in our hospital, irrespective of elevated fasting, 1-hour, or 2-hour PG diagnosis. The risk of LGA infant was globally similar to that in women with high normal glucose values.

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Keywords : gestational diabetes mellitus, hyperglycaemia and adverse pregnancy outcomes (HAPO) study, oral glucose tolerance test, pregnancy outcomes

Abbreviations : 1h-PG, 2h-PG, 95%CI, FPG, GDM, HAPO, IADPSG, OGTT, OR, PG, SD, WG, WHO