Large newborn size boosts GDM risk in next pregnancy

  • Rottenstreich M & al.
  • Diabetes Res Clin Pract
  • 10.08.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Delivery of a macrosomic or large for gestational age (LGA) neonate in a previous nondiabetic pregnancy is associated with higher rates of gestational diabetes mellitus (GDM) in subsequent pregnancy.

Why this matters

  • The Royal College of Obstetricians and Gynecologists recommends GDM testing if prior infant weighed ≥4500 g, but not for lower cutoffs or LGA.

Study design

  • Case-control study of 47,823 women with singleton pregnancy and 2 consecutive deliveries without GDM or pregestational diabetes at prior pregnancy, of whom 2.7% (n=1312) had GDM in subsequent pregnancy and 97.3% did not.
  • Funding: None.

Key results

  • Dose-dependent positive association seen between previous pregnancy birthweight and GDM in subsequent pregnancy, from 1.8% for 3821 g.
  • In multivariate analysis controlling for confounders including maternal age, parity, and BMI, independent predictors of GDM in subsequent pregnancy were (aOR):
    • LGA (>90%) history: 1.7 (P=.0);
    • Prior infant with birthweight ≥4000 g: 1.9 (P=.02); and
    • Macrosomic infant ≥4500 g: 6.0 (P<.01>
  • Women with previous infant weighing >4000 g had higher incidence in next pregnancy of:
    • LGA infant: 49.8% vs 12.7% (P<.01>
    • Infants weighing >4000 g: 29.9% vs 4.7% (P<.01>
    • Infants weighing >4500 g: 4.5% vs 0.3% (P<.01>
    • Cesarean delivery: 27.4% vs 19.6% (P<.01>

Limitations

  • Retrospective design.
  • Single-center study.