GESTATIONAL DIABETES-MELLITUS - RISK-FACTORS, OBSTETRIC COMPLICATIONSAND INFANT OUTCOMES

OBJECTIVE: To evaluate risk factors, obstetric complications and infan t outcomes in women with gestational diabetes mellitus (GDM). STUDY DE SIGN: We performed a population-based, longitudinal study of 824 women diagnosed with GDM in Nova Scotia, Canada,, between 1980 and 1993. Ad justed relative risks (RRs) with 95% confidence intervals (Cls) were e stimated through logistic regression. RESULTS: After controlling for c onfounding variables, the following were associated with all increased incidence of GDM: maternal age, pregnancy weight, previous spontaneou s or induced abortion (XX 1.41, 95% CI 1.18-1.68), previous stillbirth (RA 1.80, 95% CI 1.08-3.01), previous low birth weight infant (RR 1.4 8, 95% CI 1.03-2.14), previous high-birth-weight (HBW) infant (RX 1.51 , 95% CI 1.18-1.93) and chronic hypertension (XX 2.03, 95% CI 1.19-3.4 4). The relationship between maternal age and prepregnancy weight with GDM was nonlinear; women over age 35 and with a prepregnancy weight l ess than or equal to 49 kg or > 65 kg demonstrated an increased risk. Urinary tract infection, polyhydramnios, oligohydramnios, chronic hype rtension with superimposed preeclampsia, mild preeclampsia and uterine bleeding of unknown origin occurred more frequently in women with GDM than in those in whom the diagnosis was not made. HBW infants were mo re likely to be born to women with GDM than to women without GDM. Fina lly, women with GDM were over twice as likely to undergo cesarean birt h (RR 2.30, 95% CI 1.99-2.65). CONCLUSION: The risk of developing GDM is greatest in women over age 35, when prepregnancy weight is <49 kg o r >65 kg and in those with chronic hypertension. Pregnancies complicat ed by GDM are at risk and need to be monitored closely for obstetric c omplications and adverse infant outcomes.