Cargando…
Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012
AIMS/HYPOTHESIS: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. METHODS: All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database a...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518373/ https://www.ncbi.nlm.nih.gov/pubmed/28197657 http://dx.doi.org/10.1007/s00125-017-4206-6 |
_version_ | 1783418441357590528 |
---|---|
author | Billionnet, Cécile Mitanchez, Delphine Weill, Alain Nizard, Jacky Alla, François Hartemann, Agnès Jacqueminet, Sophie |
author_facet | Billionnet, Cécile Mitanchez, Delphine Weill, Alain Nizard, Jacky Alla, François Hartemann, Agnès Jacqueminet, Sophie |
author_sort | Billionnet, Cécile |
collection | PubMed |
description | AIMS/HYPOTHESIS: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. METHODS: All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated. RESULTS: The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother–infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]). CONCLUSIONS/INTERPRETATION: GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-017-4206-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. |
format | Online Article Text |
id | pubmed-6518373 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-65183732019-06-05 Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 Billionnet, Cécile Mitanchez, Delphine Weill, Alain Nizard, Jacky Alla, François Hartemann, Agnès Jacqueminet, Sophie Diabetologia Article AIMS/HYPOTHESIS: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. METHODS: All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated. RESULTS: The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother–infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]). CONCLUSIONS/INTERPRETATION: GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-017-4206-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. Springer Berlin Heidelberg 2017-02-15 2017 /pmc/articles/PMC6518373/ /pubmed/28197657 http://dx.doi.org/10.1007/s00125-017-4206-6 Text en © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Article Billionnet, Cécile Mitanchez, Delphine Weill, Alain Nizard, Jacky Alla, François Hartemann, Agnès Jacqueminet, Sophie Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title | Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title_full | Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title_fullStr | Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title_full_unstemmed | Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title_short | Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012 |
title_sort | gestational diabetes and adverse perinatal outcomes from 716,152 births in france in 2012 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518373/ https://www.ncbi.nlm.nih.gov/pubmed/28197657 http://dx.doi.org/10.1007/s00125-017-4206-6 |
work_keys_str_mv | AT billionnetcecile gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT mitanchezdelphine gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT weillalain gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT nizardjacky gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT allafrancois gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT hartemannagnes gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 AT jacqueminetsophie gestationaldiabetesandadverseperinataloutcomesfrom716152birthsinfrancein2012 |