Neonatal and Maternal Postpartum Outcomes Between Gestational Diabetes Mellitus A1 and A2
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Abstract
Background: Gestational diabetes mellitus is an medical complication that affects both fetuses and pregnant women. While gestational diabetes mellitus A1 (GDMA1) is diet-controlled, patients with GDMA2 require insulin treatment. From literature review, there was no previous study on the differences in neonatal and maternal postpartum outcomes between these two types of gestational diabetes mellitus (Buri Ram populations). Thus, the researchers were interested in comparing the postpartum outcomes of childbirth in order to document the consequences of both types of the condition and utilize the results in the care of patients with gestational diabetes mellitus.
Objectives: To compare neonatal and maternal postpartum outcomes among the patients with GDMA1 and GDMA2 giving birth at Buri Ram Hospital.
Methods: This study is a prognostic outcome research with retrospective observational design. The study data were collected from pregnant patients with GDMA1 and GDMA2 who gave birth at Buri Ram Hospital’s labor room during October 2018 - September 2020. Medical records of pregnant patients with GDMA1 and GDMA2 were reviewed for their pregnancy outcomes. Differences in neonatal and maternal postpartum outcomes between the two groups were analyzed using multivariable Gaussian regression and logistic regression by adjusting the influence of confounding risk factors.
Results: There were 267 patients in the GDMA1 cohort and 160 in the GDMA2 cohort. Age between 25-39 years. After adjusting the influence of various risk factors, it was found that the fetal birth weight in the GDMA2 patients was higher than the fetal birth weight in the GDMA1 patients with statistical significance. Fetuses born to GDMA2 patients also had an increased chance of being large-for-gestational-age (LGA) and macrosomia newborns when compared to fetuses born to patients with GDMA1 at the rate of 5 and 6 times respectively. Other secondary outcomes, such as preterm birth, preeclampsia, cesarean delivery, and neonatal hypoglycemia, were also significantly higher among the GDMA2 patients.
Conclusion: Gestational diabetes mellitus can have effects on both the fetus and the mother, especially the development of LGA newborns. Therefore, at-risk pregnant women should be screened for gestational diabetes mellitus in order to ensure appropriate care and advice, as well as to prevent neonatal and maternal complications during pregnancy, intrapartum, and postpartum period.
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