Gestational pre-diabetes linked to higher risk for stillbirths

Takeaway

• Women ‘at risk’ for gestational diabetes mellitus (GDM) and/or with elevated fasting plasma glucose (FPG) have an increased risk for late stillbirth.
• Significant risk reduction is possible with appropriate screening, diagnosis, management and care practices for GDM.

Why this matters

• There are differences in recommendations regarding the eligibility for GDM screening and in the diagnostic criteria for GDM.
• This is the first study to investigate the distinct and contrasting effects of underlying hyperglycaemia and diagnosis of GDM on the risk for late stillbirth.

Study design

• Midlands and North of England Stillbirth Study: prospective case-control analysis of women with a stillbirth at ≥28 weeks of gestation (n=283) and women pregnant at the time of interview (n=729) across 41 maternity units in the UK.
• Funding: Action Medical Research, Cure Kids and Sands.

Key results

• Women considered ‘at risk’ for GDM, but not screened had a 44% higher risk for late stillbirth vs those not ‘at risk’ (adjusted OR [aOR], 1.44; 95% CI, 1.01-2.06), whereas women ‘at risk’ for GDM who were screened did not experience any increase (aOR, 0.98; 95% CI, 0.70-1.36).
• Women with elevated FPG without a diagnosis of GDM had a 4 times higher risk for late stillbirth vs women with normal FPG (aOR, 4.22; 95% CI, 1.04-17.02), whereas women with elevated FPG diagnosed with GDM did not experience any increase (aOR, 1.10; 95% CI, 0.31-3.91).

Limitations

• Because less than a third of all participants were screened for GDM, the results of the subpopulation cannot be generalised to all pregnant women.