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Am J Perinatol 2020; 37(06): 589-597
DOI: 10.1055/s-0039-1683897
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perinatal Outcomes Associated with Early Diabetes Testing in Pregnancies Complicated by Obesity

John F. Mission
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
2   Department of Maternal-Fetal Medicine, Legacy Health System, Portland, Oregon
,
Janet Catov
3   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Diane Comer
4   Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Kaleab Z. Abebe
4   Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Tiffany E. Deihl
5   Department of Medicine, Ringgold Standard Institution, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Maisa Feghali
5   Department of Medicine, Ringgold Standard Institution, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Christina M. Scifres
6   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Funding This study was funded in part by the Magee-Womens Research Institute, Clinical Research Trainee Award. The funding source was not involved in the study design, collection, analysis, and interpretation of data, in the writing of the report, or the decision to submit the article for publication.
Further Information

Publication History

08 December 2018

18 February 2019

Publication Date:
20 March 2019 (online)

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Abstract

Objective This study aimed to determine whether early diabetes testing is associated with differences in perinatal outcomes among pregnant women with obesity (body mass index ≥30 kg/m2).

Study Design We conducted a retrospective cohort study of singleton pregnancies from 2012 to 2014 at a large academic medical center which examined the association of diabetes testing (HBA1c, 50 g glucose challenge test, or 100 g oral glucose tolerance test) before 24 weeks with perinatal outcomes using propensity score modeling and logistic regression.

Results Among women with obesity, 790 out of 2,698 (29.3%) underwent early diabetes testing. Propensity score modeling demonstrated that early testing was associated with higher rates of diabetes diagnosis (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.10–2.37, p = 0.01) and a trend toward small for gestational age birth weight (OR: 1.38, 95% CI: 1.00–1.90, p = 0.05) and neonatal composite morbidity (OR: 1.25, 95% CI: 1.00–1.57, p = 0.05) compared with routine testing. Women with inadequate weight gain were more likely a small for gestational age (SGA) infant if they underwent early testing compared with those with routine testing alone (19.8 vs. 11.6%, p = 0.01).

Conclusion Early testing targets higher risk women and yields a higher diabetes diagnosis rate, but inadequate weight gain in these women may increase risk SGA birth weight and neonatal morbidity. Randomized clinical trials are urgently needed to assess whether early diabetes testing improves outcomes in women with obesity.

Keywords

gestational diabetes mellitus - diabetes screening - obesity - neonatal morbidity

Note

This work was presented in part at the 37th Annual Pregnancy Meeting, the Society for Maternal-Fetal Medicine, Las Vegas, NV, January 23–28, 2017.