Perinatal Outcomes in Early and Late Gestational Diabetes Mellitus After Treatment From 24–28 Weeks’ Gestation: A TOBOGM Secondary Analysis
Abstract
Objective In most gestational diabetes mellitus (GDM) studies, cohorts have included women combined into study populations without regard to whether hyperglycemia was present earlier in pregnancy. In this study we sought to compare perinatal outcomes between groups: women with early GDM (EGDM group: diagnosis before 20 weeks' gestation but no treatment until 24-28 weeks' gestation if GDM still present), with late GDM (LGDM group: present only at 24-28 weeks' gestation), and with normoglycemia at 24-28 weeks' gestation (control participants). Research design and methods This is a secondary analysis of a randomized controlled treatment trial where we studied, among women with risk factors, early ( Results Women with EGDM (n = 254) and LGDM (n = 467) had shorter pregnancy duration than control participants (n = 2,339). BMI was lowest with LGDM. The composite was increased with EGDM (odds ratio [OR] 1.59, 95% CI 1.18-2.12) but not LGDM (OR 1.19, 95% CI 0.94-1.50). Induction of labor was higher in both GDM groups. In comparisons with control participants there were higher birth centile, higher preterm birth rate, and higher rate of neonatal jaundice for the EGDM group (but not the LGDM group). The greatest need for insulin and/or metformin was with EGDM. Conclusions Adverse perinatal outcomes were increased with EGDM despite treatment from 24-28 weeks' gestation, suggesting the need to initiate treatment early, and more aggressively, to reduce the effects of exposure to the more s…
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A secondary analysis of the TOBOGM study showed that adverse perinatal outcomes were increased with GDM diagnosed during the first half of pregnancy, despite treatment from 24 to 28 weeks' gestation, compared with GDM diagnosed during the second half of pregnancy.
“GDM diagnosed during the first half of pregnancy, despite treatment from 24 to 28 weeks' gestation, compared with GDM diagnosed during the second half of pregnancy 16 .”
From Clinical challenges in early pregnancy in Japan: An update on gestational diabetes (2024) · cites this paper as [16]
Cites
Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy
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Self-citationEffect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study
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Bastian, B., Smithers, L. G., Pape, A., Davis, W., Fu, K., & Francois, M. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111890 · Cited by 18 · see citing works
Clinical challenges in early pregnancy in Japan: An update on gestational diabetes
Sugiyama, T., Kawasaki, M., & Arata, N. (2024) · Journal of Diabetes Investigation · doi:10.1111/jdi.14319
- Authors
- Simmons, D., Immanuel, J., Hague, W. M., Teede, H., Nolan, C. J., Peek, M. J., Flack, J. R., McLean, M., Wong, V., Hibbert, E. J., Kautzky-Willer, A., Harreiter, J., Backman, H., Gianatti, E., Sweeting, A., Mohan, V., Cheung, N. W., TOBOGM Research Group, Simmons, D., Cheung, N. W., Immanuel, J., Hague, W. M., Teede, H., Nolan, C. J., Peek, M. J., Flack, J. R., McLean, M., Wong, V., Hibbert, E., Gianatti, E., Sweeting, A., Coat, S., Dalal, R., Soldatos, G., Padmanabhan, S., Rajagopal, R., Rudland, V., Harreiter, J., Kautzky-Willer, A., Kiss, H., Backman, H., Schwarcz, E., Ross, G., Mohan, V., Mohan Anjana, R., & Ram, U.
- Affiliations
- 9Nepean Clinical School, University of Sydney, and Nepean Hospital, Sydney, New South Wales, Australia
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2024-02-29
- Volume
- 47
- Issue
- 12
- Pages
- 2093-2101
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W4392297962
- Cited by
- 36
- References
- 5
- Citations by year
- 2026: 20 · 2025: 9 · 2024: 7
- FWCI
- 19.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- South Western Sydney Local Health District Academic Unit
- Medical Scientific Fund of the Mayor of Vienna (project numbers 15205 and 23026)
- National Health and Medical Research Council (1104231, 2009326)
- Region Örebro Research Committee (15205, 23026, OLL-942177, OLL-970566)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, perinatal outcomes, hyperglycemia in pregnancy, preterm birth, birth weight, neonatal jaundice, labor induction, insulin therapy, metformin, gestation length, birth trauma, neonatal respiratory distress, stillbirth, shoulder dystocia
- MeSH terms
- Adult, Birth Weight, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Diabetes, Gestational
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