Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK

Tomasina Stacey, Peter Tennant, Lesley McCowan, Edwin Mitchell, Jayne Budd, Minglan Li, John Thompson, Bill L Martin, Devender Roberts, Alexander EP Heazell

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

LanguageEnglish
Pages973-982
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume126
Issue number8
Early online date19 Mar 2019
DOIs
Publication statusPublished - 1 Jul 2019

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Stillbirth
Gestational Diabetes
England
Case-Control Studies
Fasting
Glucose
Odds Ratio
Pregnancy

Cite this

Stacey, Tomasina ; Tennant, Peter ; McCowan, Lesley ; Mitchell, Edwin ; Budd, Jayne ; Li, Minglan ; Thompson, John ; Martin, Bill L ; Roberts, Devender ; Heazell, Alexander EP. / Gestational diabetes and the risk of late stillbirth : a case-control study from England, UK. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2019 ; Vol. 126, No. 8. pp. 973-982.
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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.",
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Stacey, T, Tennant, P, McCowan, L, Mitchell, E, Budd, J, Li, M, Thompson, J, Martin, BL, Roberts, D & Heazell, AEP 2019, 'Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 126, no. 8, pp. 973-982. https://doi.org/10.1111/1471-0528.15659

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 journalArticle

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T1 - Gestational diabetes and the risk of late stillbirth

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

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

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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

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