AIIMS Study: Overt Diabetes in Pregnancy Associated with Higher Risks of Stillbirth, Macrosomia, and Postpartum Diabetes

"Women with ODiP had a 93% higher risk of gestational hypertension, a 65% greater risk of pre-eclampsia, and a 14% increased likelihood of cesarean delivery. Their babies also faced elevated risks of stillbirth (RR 4.30), macrosomia (RR 1.66), neonatal hypoglycemia (RR 1.52), and being large for gestational age (RR 1.45)," the researchers reported in Diabetes, Obesity and Metabolism, adding that, "Postpartum, ODiP increased the risk of developing diabetes sixfold compared to GDM and 25-fold compared to normoglycemia, highlighting the need for continued clinical follow-up."

Overt diabetes in pregnancy (ODiP), first defined by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) in 2010, refers to diabetes first diagnosed during pregnancy that meets the criteria for non-gestational diabetes. It is often considered an undiagnosed pre-existing type 2 diabetes and, unlike gestational diabetes, may persist beyond childbirth, leading to long-term health complications for both mother and child.

Despite its clinical importance, limited data from previous studies—mainly due to small sample sizes—have restricted our understanding of ODiP. To address this, Yashdeep Gupta, Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India, and colleagues aimed to consolidate evidence on pregnancy and postpartum outcomes in women with ODiP compared to those with gestational diabetes mellitus, pre-existing diabetes (PED), and normoglycaemia.

For this purpose, the researchers conducted a thorough search across PubMed, Embase, and Scopus for relevant studies published between January 1, 2010, and May 31, 2024. Eleven studies, encompassing data from 16,135 pregnancies, were analyzed.

The study revealed the following findings:

• Women with ODiP had a significantly higher risk of gestational hypertension (RR 1.93), pre-eclampsia (RR 1.65), and caesarean delivery (RR 1.14) compared to those with GDM.
• Neonatal outcomes were also worse in women with ODiP, with higher risks of large for gestational age (RR 1.45), macrosomia (RR 1.66), neonatal hypoglycaemia (RR 1.52), and stillbirth (RR 4.30).
• The risk of developing postpartum diabetes was six times higher in women with ODiP compared to those with GDM and 25 times higher than those with normoglycaemia.
• Variations in diagnostic criteria and postpartum follow-up duration contributed to the observed heterogeneity in the findings.

"This systematic review and meta-analysis highlight that ODiP is linked to worse pregnancy and postpartum outcomes compared to GDM and normoglycaemia. The findings emphasize the importance of implementing targeted clinical strategies to manage ODiP and reduce adverse outcomes for both mothers and their babies," the authors concluded.

Reference: https://doi.org/10.1111/dom.16400