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Compliance with blood glucose testing and gestational weight gain in patients with gestational diabetes: A secondary analysis

Jenani Jayakumaran, Melissa Lott D O, Daniela Gomez, Hector Figueroa-Hernandez, A Dhanya Mackeen, Michael J Paglia, Cara Nordberg and Meike Schuster

 Excessive gestational weight gain (GWG) and obesity are related to increased morbidity. We aimed to compare adverse birth outcomes in obese vs. non-obese women with gestational DM (GDM) and GWG adherence with Institute of drugs (IOM) recommendations in women compliant vs. non-compliant with blood glucose (BG) testing. We conducted a secondary analysis of a randomized controlled trial at five tertiary medical centers from 5/2013-5/2016 evaluating the frequency of BG testing (everyday vs. every other day) among women with GDM. Abnormal BG values included fasting ≥95mg/dl or 2-hr postprandial ≥120mg/dl. Women’s weights were categorized based on the international BMI classification. Compliance with BG testing was defined as 90% of expected BG values. GWG was assessed for adherence to IOM recommendations. Primary maternal outcomes included primary cesarean section, labor dystocia, shoulder dystocia, and delivery due to uncontrolled diabetes. Primary neonatal outcomes included NICU admission, neonatal hypoglycemia, macrosomia, hyperbilirubinemia or respiratory distress syndrome. Composite outcomes were evaluated. Fisher exact or Chi-square tests were used as appropriate. Two hundred and eighty-seven women were included during this analysis. Maternal and neonatal adverse outcomes didn't differ between BG testing groups when stratified by non-obese vs. obese. Pooled BG testing groups demonstrated macrosomia (p=0.0157) and the neonatal outcome composite (p=0.0042) were significantly more common in obese vs. non-obese women. When stratified by obesity class, maternal and neonatal outcomes did not differ between testing groups. GWG was more likely to be within IOM guidelines in compliant vs. noncompliant women (p=0.0283). Pooled BG testing groups stratified by obesity showed no difference in GWG between non-obese vs. obese women in the compliant vs. non-compliant groups. Our results support obesity as an additional risk factor for adverse pregnancy outcomes in women with GDM and suggest improved adherence with IOM GWG guidelines amongst compliant patients.

Gestational diabetes mellitus (GDM) is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus. If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes. This review provides an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.