Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Comprehensive Literature Review
2.2. Retrospective Study at Mayo Clinic
3. Epidemiology of GDM Recurrence
4. Single-Center Experience of GDM Recurrence
4.1. Results
4.2. Discussion
5. Prevention of Recurrent GDM
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Meta-Analyses | N (with GDM in Index Pregnancy) | GDM Recurrence | Clinical Risk Factors for Recurrence |
Kim et al., 2007 [17] | 13 studies—11 retrospective cohorts, 2 case-control studies; 3790 women | 30–84% in retrospective cohorts; OR 15–23 for case control studies | Minority populations: African American, Latina, Asian |
Schwartz et al., 2016 [14] | 14 cross-sectional cohort studies; 9211 women | 30–80% | Maternal age Maternal BMI Inter-pregnancy weight gain OGTT glucose concentrations Use of insulin Multiparity Fetal macrosomia |
Individual Studies | N (with GDM in Index Pregnancy), Location of Study | GDM Recurrence | Clinical Risk Factors for Recurrence |
Getahun et al., 2010 [21] | 2351, USA | 52% | Ethnicity: Hispanic & Asian/Pacific Islanders |
Ehrlich et al., 2011 [22] | 1028, USA | 38% | Inter-pregnancy weight gain |
England et al., 2015 [23] | 4102, USA | 34–48% | Maternal age Born outside of United States |
Wong et al., 2019 [24] | 3587, Australia | 73% | Maternal BMI OGTT glucose concentrations Inter-pregnancy weight gain |
Wang et al., 2019 [25] | 143, China | 55% | OGTT glucose concentrations First trimester triglycerides |
Characteristic at Time of 1st Pregnancy | GDM in 2nd Pregnancy | |
---|---|---|
No (n = 22) | Yes (n = 20) | |
Maternal race | ||
Asian | 0 (0.0%) | 1 (5.0%) |
Black or African American | 2 (9.1%) | 0 (0.0%) |
White | 20 (90.9%) | 18 (90.0%) |
Unknown/Not Reported | 0 (0.0%) | 1 (5.0%) |
Maternal Age (years), Mean (SD) | 27.3 (3.8) * | 30.0 (4.0) * |
BMI (kg/m2) (<20/40 gestation), Mean (SD) | 30.0 (8.8) | 30.3 (5.9) |
Current smoking | 2 (9.1%) | 1 (5.0%) |
History of Infertility | 3 (13.6%) | 7 (35.0%) |
First degree relatives with diabetes | ||
No | 13 (59.1%) | 19 (95.0%) |
Yes | 6 (27.3%) | 0 (0.0%) |
Unknown | 3 (13.6%) | 1 (5.0%) |
Characteristic at Time of 2nd Pregnancy | ||
Maternal Age (years), Mean (SD) | 29.1 (3.9) | 32.1 (4.1) |
BMI (kg/m2) (<20/40 gestation), Mean (SD) | 29.8 (8.3) | 30.2 (5.6) |
Months between deliveries, Mean (SD) | 20.9 (6.1) | 24.2 (8.4) |
Maternal Outcomes | GDM in 2nd Pregnancy | |
---|---|---|
No (n = 22) | Yes (n = 20) | |
Gestational age at GDM diagnosis, Mean (SD) | 28.4 (1.6) | 27.0 (1.9) |
Diabetes Management | ||
Diet and lifestyle modifications | 15 (68.2%) | 11 (55.0%) |
Glyburide | 7 (31.8%) | 9 (45.0%) |
Insulin | 0 | 0 |
Pregnancy-induced hypertension | 3 (13.6%) | 4 (20.0%) |
Pre-eclampsia | 3 (13.6%) | 2 (10.0%) |
Type of Labor | ||
Spontaneous onset of labor at term | 6 (27.3%) | 11 (55.0%) |
Induction | 14 (63.6%) | 8 (40.0%) |
Preterm onset of labor (PTL) | 2 (9.1%) | 1 (5.0%) |
Method of Delivery | ||
Vaginal Delivery | 12 (54.5%) | 14 (70.0%) |
Cesarean | 10 (45.5%) | 6 (30.0%) |
Infant Outcomes | ||
Birth Outcome | ||
Live Birth—Term (greater than 37 weeks gest.) | 16 (72.7%) | 15 (75.0%) |
Live Birth—Preterm (less than 37 weeks gest.) | 6 (27.3%) | 4 (20.0%) |
Stillbirth | 0 (0.0%) | 1 (5.0%) |
Gestational age at delivery (weeks) | ||
Mean (SD) | 38.5 (2.4) | 38.8 (1.9) |
Infants with research authorization | (N = 19) | (N = 16) |
Admission to neonatal intensive care unit | 0 | 1 (6.3%) |
Admission to high dependency unit | 9 (47.4%) | 7 (43.8%) |
Shoulder dystocia | 1 (5.3%) | 0 |
Neonatal hypoglycemia | 7 (36.8%) | 10 (62.5%) |
Neonatal death | 0 | 1 (6.3%) |
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Egan, A.M.; Enninga, E.A.L.; Alrahmani, L.; Weaver, A.L.; Sarras, M.P.; Ruano, R. Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience. J. Clin. Med. 2021, 10, 569. https://doi.org/10.3390/jcm10040569
Egan AM, Enninga EAL, Alrahmani L, Weaver AL, Sarras MP, Ruano R. Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience. Journal of Clinical Medicine. 2021; 10(4):569. https://doi.org/10.3390/jcm10040569
Chicago/Turabian StyleEgan, Aoife M., Elizabeth Ann L. Enninga, Layan Alrahmani, Amy L. Weaver, Michael P. Sarras, and Rodrigo Ruano. 2021. "Recurrent Gestational Diabetes Mellitus: A Narrative Review and Single-Center Experience" Journal of Clinical Medicine 10, no. 4: 569. https://doi.org/10.3390/jcm10040569