Abstract
Objective: To explore the separate effects of being ‘at risk’ of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. Design: Prospective case–control study. Setting: Forty-one maternity units in the UK. Population: Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). Methods: Causal mediation analysis explored the joint effects of (i) ‘at risk’ of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. Main outcome measures: Screening for GDM and FPG levels. Results: Women ‘at risk’ of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not ‘at risk’ (aOR 1.44, 95% CI 1.01–2.06). Women ‘at risk’ of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70–1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04–17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31–3.91). Conclusions: Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women ‘at risk’ of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. Tweetable abstract: Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
| Original language | English |
|---|---|
| Pages (from-to) | 973-982 |
| Number of pages | 10 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Volume | 126 |
| Issue number | 8 |
| Early online date | 19 Mar 2019 |
| DOIs | |
| Publication status | Published - 1 Jul 2019 |
Fingerprint
Cite this
}
Gestational diabetes and the risk of late stillbirth : a case-control study from England, UK. / Stacey, Tomasina; Tennant, Peter; McCowan, Lesley; Mitchell, Edwin; Budd, Jayne; Li, Minglan; Thompson, John; Martin, Bill L; Roberts, Devender; Heazell, Alexander EP.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 126, No. 8, 01.07.2019, p. 973-982.Research output: Contribution to journal › Article
TY - JOUR
T1 - Gestational diabetes and the risk of late stillbirth
T2 - a case-control study from England, UK
AU - Stacey, Tomasina
AU - Tennant, Peter
AU - McCowan, Lesley
AU - Mitchell, Edwin
AU - Budd, Jayne
AU - Li, Minglan
AU - Thompson, John
AU - Martin, Bill L
AU - Roberts, Devender
AU - Heazell, Alexander EP
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Objective: To explore the separate effects of being ‘at risk’ of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. Design: Prospective case–control study. Setting: Forty-one maternity units in the UK. Population: Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). Methods: Causal mediation analysis explored the joint effects of (i) ‘at risk’ of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. Main outcome measures: Screening for GDM and FPG levels. Results: Women ‘at risk’ of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not ‘at risk’ (aOR 1.44, 95% CI 1.01–2.06). Women ‘at risk’ of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70–1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04–17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31–3.91). Conclusions: Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women ‘at risk’ of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. Tweetable abstract: Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
AB - Objective: To explore the separate effects of being ‘at risk’ of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. Design: Prospective case–control study. Setting: Forty-one maternity units in the UK. Population: Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733). Methods: Causal mediation analysis explored the joint effects of (i) ‘at risk’ of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs. Main outcome measures: Screening for GDM and FPG levels. Results: Women ‘at risk’ of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not ‘at risk’ (aOR 1.44, 95% CI 1.01–2.06). Women ‘at risk’ of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70–1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04–17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31–3.91). Conclusions: Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women ‘at risk’ of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth. Tweetable abstract: Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
KW - Stillbirth
KW - Gestational diabetes mellitus
KW - Pregnancy
KW - pregnancy
KW - stillbirth
UR - https://doi.org/10.1111/1471-0528.15810
UR - http://www.scopus.com/inward/record.url?scp=85066933525&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.15659
DO - 10.1111/1471-0528.15659
M3 - Article
VL - 126
SP - 973
EP - 982
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
SN - 1470-0328
IS - 8
ER -