Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 26;12(9):e065063.
doi: 10.1136/bmjopen-2022-065063.

Pregnancy outcomes in women with gestational diabetes mellitus by models of care: a retrospective cohort study

Jackson Harrison  1   2 , Sarah Melov  1   2 , Adrienne C Kirby  2   3 , Neil Athayde  2 , Araz Boghossian  2 , Wah Cheung  1   4 , Emma Inglis  2 , Kavita Maravar  2 , Suja Padmanabhan  4 , Melissa Luig  5 , Monica Hook  2 , Dharmintra Pasupathy  6   2
Affiliations
Free PMC article

Pregnancy outcomes in women with gestational diabetes mellitus by models of care: a retrospective cohort study

Jackson Harrison et al. BMJ Open. .
Free PMC article

Abstract

Objective: To compare birth outcomes of women with gestational diabetes mellitus (GDM) with background obstetric population, stratified by models of care.

Design: Retrospective cohort study.

Setting: A tertiary referral centre in Sydney, Australia.

Participants: All births 1 January 2018 to 30 November 2020. Births <24 weeks, multiple gestations and women with pre-existing diabetes were excluded.

Methods: Data were obtained from electronic medical records. Women were classified according to GDM status and last clinic attended prior to delivery. Model of care included attendance at dedicated GDM obstetric clinics, and routine antenatal care.

Main outcome measures: Hypertensive disorders of pregnancy (HDP), pre-term birth (PTB), induction of labour (IOL), operative delivery, small for gestational age (SGA), large for gestational age, postpartum haemorrhage, obstetric anal sphincter injury (OASIS), neonatal hypoglycaemia, neonatal hypothermia, neonatal respiratory distress, neonatal intensive care unit (NICU) admission.

Results: The GDM rate was 16.3%, with 34.0% of women managed in dedicated GDM clinics. Women with GDM had higher rates of several adverse outcomes. Only women with GDM attending non-dedicated clinics had increased odds of HDP (adjusted OR (adj OR) 1.6, 95% CI 1.2 to 2.0), PTB (adj OR 1.7, 95% CI 1.4 to 2.0), OASIS (adj OR 1.4, 95% CI 1.0 to 2.0), similar odds of induction (adj OR 1.0, 95% CI 0.9 to 1.1) compared with non-GDM women. There were increased odds of NICU admission (adj OR 1.5, 95% CI 1.3 to 1.8) similar to women attending high-risk GDM clinics.

Conclusions: Women with GDM receiving care in lower risk clinics had similar or higher rates of adverse outcomes. Pathways of care need to be similar in all women with GDM.

Keywords: clinical audit; diabetes in pregnancy; obstetrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cases included for analysis. GDM, gestational diabetes mellitus.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Laurie JG, McIntyre HD. A review of the current status of gestational diabetes mellitus in Australia-The clinical impact of changing population demographics and diagnostic criteria on prevalence. Int J Environ Res Public Health 2020;17. 10.3390/ijerph17249387. [Epub ahead of print: 15 12 2020]. - DOI - PMC - PubMed
    1. Kim C. Gestational diabetes: risks, management, and treatment options. Int J Womens Health 2010;2:339. 10.2147/IJWH.S13333 - DOI - PMC - PubMed
    1. Metzger BE, Gabbe SG, Persson B, et al. . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:e98–82. 10.2337/dc10-0719 - DOI - PMC - PubMed
    1. Metzger B, Lowe L, Dyer A. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2009;358:1991–2002. 10.1056/NEJMoa0707943 - DOI - PubMed
    1. Crowther CA, Hiller JE, Moss JR, et al. . Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. 10.1056/NEJMoa042973 - DOI - PubMed