The impact on pregnancy outcomes of late-onset gestational diabetes mellitus diagnosed during the third trimester: A systematic review and meta-analysis

Inshirah Sgayer; Marwan Odeh; Maya Frank Wolf; Raneen Sawaid Kaiyal; Ala Aiob; Lior Lowenstein; Eduard Gratacos

doi:10.1002/ijgo.15254

The impact on pregnancy outcomes of late-onset gestational diabetes mellitus diagnosed during the third trimester: A systematic review and meta-analysis

Int J Gynaecol Obstet. 2023 Nov 21. doi: 10.1002/ijgo.15254. Online ahead of print.

Authors

Inshirah Sgayer^{1

2}, Marwan Odeh^{1

2}, Maya Frank Wolf^{1

2}, Raneen Sawaid Kaiyal³, Ala Aiob^{1

2}, Lior Lowenstein^{1

2}, Eduard Gratacos⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
² Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
³ Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁴ BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain.

PMID: 37987501
DOI: 10.1002/ijgo.15254

Abstract

Background: Evidence is inconsistent regarding the impact of late gestational diabetes mellitus (GDM) on perinatal outcomes.

Objectives: To evaluate associations of GDM diagnosed in the third trimester (late GDM) with adverse obstetric and neonatal outcomes.

Search strategy: We searched Embase, Medline, and Web of Science from January 1, 1990 to June 16, 2022, for observational studies.

Selection criteria: Late GDM was defined as a de novo diagnosis, i.e. after a negative screening for diabetes in the second trimester, and at later than 28 weeks of pregnancy.

Data collection and analysis: Each abstract and full-text article was independently reviewed by the same two authors. Quality was assessed with the use of the Newcastle-Ottawa Scale. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model.

Main results: Twelve studies were identified as meeting the inclusion criteria, including 3103 patients (571 with late GDM and 3103 controls). Incidences of shoulder dystocia (OR 1.57, 95% CI 1.02-2.42, P = 0.040), 5-minute Apgar score <7 (OR 1.80, 95% CI 1.14-2.86, P = 0.024), cesarean delivery (OR 1.98, 95% CI 1.51-2.60, P < 0.001), and emergent cesarean delivery (OR 1.57, 95% CI 1.02-2.40, P = 0.040) were significantly higher among women with late GDM than among the controls. The groups showed similarity in the rates of fetal macrosomia, large-for-gestational-age fetuses, neonatal hypoglycemia, and hypertensive disorders of pregnancy.

Conclusions: This meta-analysis showed associations of late GDM with increased adverse perinatal outcomes. Prospective studies should evaluate the impact on perinatal outcomes of repeated third-trimester screening for late GDM.

Keywords: cesarean section; gestational diabetes; late-onset; meta-analysis; perinatal outcome; third trimester.

Publication types

Review