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The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study.

Abstract：

AIMS:To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS:Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. RESULTS:Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight). CONCLUSIONS:A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.

journal_name

Acta Diabetol

journal_title

Acta diabetologica

authors

Pintaudi B,Fresa R,Dalfrà M,Dodesini AR,Vitacolonna E,Tumminia A,Sciacca L,Lencioni C,Marcone T,Lucisano G,Nicolucci A,Bonomo M,Napoli A,STRONG Study Collaborators.

doi

10.1007/s00592-018-1208-x

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

1261-1273

issue

12

eissn

0940-5429

issn

1432-5233

pii

10.1007/s00592-018-1208-x

journal_volume

55

pub_type

杂志文章,多中心研究

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