Perinatal Outcomes of Early and Late Gestational Diabetes

Early gestational diabetes mellitus (GDM) is associated with an increased incidence of adverse perinatal outcomes despite treatment beginning at 24–28 weeks of gestation, according to a secondary analysis of the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial published online Dec. 1, 2024 in the journal Diabetes Care.¹

This randomized controlled treatment trial evaluated early gestational diabetes mellitus (GDM) (<20 weeks' gestation) among women with risk factors, using the World Health Organization 2013 criteria. Women receiving early treatment for GDM were not included in the study. GDM was treated only if it persisted at 24–28 weeks of gestation. The primary outcome was a composite measure, including preterm birth (<37 weeks of gestation), birth weight ≥4,500 g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth or neonatal death, and shoulder dystocia. The aim was to compare perinatal outcomes among three distinct groups of participants: 254 women with early GDM (diagnosed before 20 weeks of gestation but untreated until 24 to 28 weeks of gestation, if GDM persisted) and 467 women with late GDM (diagnosed only at 24–28 weeks' gestation). A total of 2339 women with normoglycemia at 24 to 28 weeks of gestation acted as the control group).

Women with early and late gestational diabetes experienced shorter pregnancy durations compared to the control group. Participants with late GDM had the lowest BMI. The incidence of the composite outcome was higher in the group with early GDM with odds ratio (OR) of 1.59. But this was not observed in the late GDM group (OR 1.19). Both GDM groups had higher rates of labor induction compared to controls. The early GDM group had higher birth centiles, increased rates of preterm birth, and a higher incidence of neonatal jaundice. Additionally, this group had the greatest need for insulin and/or metformin treatment.

These findings highlight the need for early screening and treatment initiation to mitigate the impact of prolonged exposure to severe maternal hyperglycemia from early pregnancy and reduce perinatal complications.

Reference

1.   David Simmons, et al; TOBOGM Research Group. Perinatal outcomes in early and late gestational diabetes mellitus after treatment from 24-28 weeks' gestation: A TOBOGM secondary analysis. Diabetes Care. 2024 Dec 1;47(12):2093-2101. doi: 10.2337/dc23-1667.