ADVERSE PREGNANCY OUTCOMES AND GESTATIONAL DIABETES: FROM THE HAPO STUDY TO CURRENT DATA


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Abstract

Numerous studies show a significant (2-fold) increase in the frequency of diabetes in pregnant women over the past 20 years. Objective. To present the results of retrospective cohort studies covering at least a thousand women diagnosed with diabetes mellitus detected both before and during pregnancy, as well as with hyperglycemia that is undiagnosed as diabetes mellitus in comparison with patients with normal glucose levels. Materials and methods. When preparing the review, the authors used the data obtained after the publication of the reports of the International Consortium of Researchers of Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) in 1998-2014. The search was carried out using the PubMed database until June 2020. Results. According to HAPO, the frequency of large fetuses with the lowest glucose level (Category 1) was only 5.3%, while that with the highest level (Category 7) was 26.3%; the frequency of primary caesarean section was 13.3% and 27.9%, respectively; that of clinical hyperglycemia of newborns was 3.7% and 32.4%, respectively. The odds ratio (OR) of adverse perinatal outcomes with an increase in the plasma glucose concentration by 1 standard deviation (SD) was also shown: 0.4 mmol/l on an empty stomach, 1.7 mmol/l after 1 hour and 1.3 mmol/l after 2 hours. The strongest associations were found in preeclampsia (OR 1.21 to 1.28); shoulder dystocia or a birth injury (OR 1.20) Conclusion. This study has made many countries, including Russia, review the criteria for gestational diabetes. However, in recent years, other researchers have also published data that suggest the need for even closer attention to the problem of hyperglycemic disorders in pregnant women to improve perinatal outcomes.

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About the authors

Elena A. Mateykovich

Tyumen State Medical University, Ministry of Health of the Russian Federation

Email: mat-maxim@yandex.ru
Med. Sci., associate professor of the Department of Obstetrics and Gynecology 54 Odesskaya str., Tyumen, 625023, Russia

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