Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar

Objective To compare pregnancy outcomes in patients with early versus usual gestational diabetes mellitus (GDM). Design A retrospective cohort study. Settings The Women's Hospital, Hamad Medical Corporation, Qatar. Participants GDM women who attended and delivered in the Women's Hospital, between January and December 2016. GDM was diagnosed based on the 2013-WHO criteria. The study included 801 patients; of which, 273 E-GDM and 528 U-GDM. Early GDM (E-GDM) and usual GDM (U-GDM) were defined as GDM detected before and after 24 weeks' gestation, respectively. Outcomes Maternal and neonatal outcomes and the impact of timing of GDM-diagnosis on pregnancy outcomes. Results At conception, E-GDM women were older (mean age 33.5 +/- 5.4 vs 32.0 +/- 5.4 years, p<0.001) and had higher body mass index (33.0 +/- 6.3 vs 31.7 +/- 6.1 kg/m(2), p=0.0059) compared with U-GDM. The mean fasting, and 1-hour blood glucose levels were significantly higher in E-GDM vs U-GDM, respectively (5.3 +/- 0.7 vs 4.0 +/- 0.7 mmol/L, p<0.001 and 10.6 +/- 1.7 vs 10.3 +/- 1.6 mmol/L, p<0.001). More patients in the U-GDM were managed on diet alone compared with E-GDM (53.6% vs 27.5%, p<0.001). E-GDM subjects gained less weight per week compared with U-GDM (0.02 +/- 0.03 vs 0.12 +/- 0.03 kg/week, p=0.0274). Maternal outcomes were similar between the two groups apart from a higher incidence of pre-term labour (25.5% vs 14.4%; p<0.001) and caesarean section (52.4% vs 42.8%; p=0.01) in E-GDM vs U-GDM, respectively. After correction for covariates; gestational age at which GDM was diagnosed was associated with increased risk of macrosomia (OR 1.06, 95% CI 1.00 to 1.11; p<0.05) and neonatal hypoglycaemia (OR 1.05, 95% CI 1.00 to 1.11; p<0.05). Conclusion Our data support the concept of early screening and treatment of GDM in high-risk patients. More data are needed to examine the optimal time for screening.