Endocrine Abstracts (2018) 53 CD1.3 | DOI: 10.1530/endoabs.53.CD1.3

Early screening for gestational diabetes in obese pregnant women is associated with improved neonatal and maternal outcomes

David Ryan1, Laura Haddow1 & Rebecca Reynolds2

1Edinburgh Medical School, Edinburgh, UK; 2Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK.

Gestational Diabetes (GDM) complicates 3–5% of all UK pregnancies but prevalence is increasing with rising rates of maternal obesity. Adaptions to the GDM screening protocol within NHS Lothian in August 2016 to screen high-risk women including women with obesity (BMI≥30 kg/m2) during early pregnancy (approximately 10 weeks gestation) allowed us to test the hypothesis that early screening of obese pregnant women would be associated with improved maternal and neonatal outcomes. We conducted a retrospective clinical audit among all women with a singleton pregnancy diagnosed with GDM and delivering their baby at Royal Infirmary Edinburgh, from January 1st 2015 to 31st October 2017. 351 (66%) women were diagnosed using the pre-August 2016 pathway (protocol 1) while 180 (34%) were diagnosed using the early screening protocol (protocol 2). Data were extracted from NHS Lothian’s electronic records to investigate effects of protocol 2 on GDM management and outcomes according to maternal BMI. 59.7% of women (n=317) diagnosed with GDM were obese. Obese had higher rates of adverse primary outcomes (composite of emergency caesarean section, macrosomia, and neonatal hypoglycaemia, P<0.05) and neonatal complications (P<0.05). Obese in protocol 2 were diagnosed earlier (143.5 (59.3) vs 184.5 (48.7) days of gestation, P<0.001), spent more time on diet therapy (63.5 (60.4) vs 46.9 (40.6) days of gestation, P<0.05) and started metformin earlier (182.4 (51.0) vs 204.1 (45.7) days of gestation, P<0.05) compared to obese diagnosed with protocol 1. There was no associated increase in the duration of insulin therapy. Obese diagnosed with protocol 2 had a significant reduction of adverse primary outcomes compared to obese diagnosed using protocol 1 (n=36 (33.0%) vs n=96 (46.4%), P<0.05), neonatal complications (n=37 (33.9%) vs n=97 (46.6%), P<0.05) and maternal complications (n=59 (54.1%) vs n=141 (67.8%), P<0.05). Obese pregnant women represent a high-risk cohort within the GDM population. Early glycaemic screening is associated with improvements in maternal and neonatal outcomes for an obese cohort. This could be mediated by reduced gestational weight gain, increased duration of lifestyle interventions or more interactions with healthcare professionals.

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