Better Pregnancy Spacing Would Aid Those With Gestational Diabetes

Becky McCall

July 02, 2020

Women with a history of gestational diabetes were 50% more likely to have a short interval between pregnancies (18 months or less) compared with women without gestational diabetes, in a new study.

The findings suggest a possible modifiable risk factor to improve outcomes, said lead researcher Ronald Anguzu, MBChB, MPH, Medical College of Wisconsin, Milwaukee, who presented the results during the virtual American Diabetes Association (ADA) 80th Scientific Sessions.

"Intervening to lengthen these intervals might provide opportunity for pre-conception counseling as well as screening and management of type 2 diabetes — optimizing glycemia that could be present in these patients," he remarked. 

"Conception that occurs in the setting of undiagnosed or uncontrolled diabetes carries significant health risks both to the mother and the fetus," he stressed.

"So promoting education and strategies for recommended pregnancy spacing in this high-risk population is of utmost importance."

Anguzu's abstract was selected for presentation based on scores of the planning committee and the novelty of the work, said Mary R. Loeken, PhD, chair of the ADA Scientific Sessions Planning Subcommittee on Pregnancy and Reproductive Health, as well as associate professor at Harvard Medical School, Boston, Massachusetts.

"For women with gestational diabetes, a short interpregnancy interval reduces the likelihood that she will lose pregnancy-associated weight gain, and this increases the likelihood of gestational diabetes in a subsequent pregnancy," Loeken pointed out.

"Counseling women with prior gestational diabetes to space their pregnancies may improve the health of both the mother and fetus in subsequent pregnancies," she added.

She highlighted concerns that women who have had gestational diabetes are at high risk of progressing to type 2 diabetes.

"Entering pregnancy with type 2 diabetes poses" increased risks for the mother and fetus, including the possibility of congenital malformations, she also noted.

Advise Women With Gestational Diabetes to Space Pregnancies

The literature suggests intervals of 18 months or less between pregnancies are associated with adverse maternal and fetal outcomes, such as spontaneous abortion, pre-term birth, and low birth weight, Anguzu said.

Consequently, his team wanted to discover whether women with a history of gestational diabetes have a higher number of short interpregnancy intervals compared with those who don't develop the condition.

They examined data from over 28,000 women aged 18-44 years from the National Survey on Family Growth datasets for 2011-2017.

The primary outcome was the number of short interpregnancy intervals (conception < 18 months from a prior birth) in women with a history of gestational diabetes versus those without. Women with pregnancy intervals greater than 60 months were excluded due to higher rates of adverse pregnancy outcomes.

Researchers found a history of gestational diabetes among 9.9% of participants, and these women had a slightly higher mean maternal age compared to women without a history of gestational diabetes, at 36.3 versus 34.3 years (P < .001).

Mean body mass index (BMI), at 31.3 kg/m2 in those with gestational diabetes, was also higher than those without a history, at 27.9 kg/m2.

Private medical insurance was held by nearly 49% of women without a history of gestational diabetes compared with just over 4% with such a history (P = .002).

"The proportion of short interpregnancy intervals was higher in women with a history of gestational diabetes compared to women without gestational diabetes, and this reached statistical significance (56.4% vs 43.6%; P < .001)," reported Anguzu.

The odds ratio of having short interpregnancy intervals if the women had a history of gestational diabetes was 1.43 (95% CI, 1.22 - 1.66) compared to women without gestational diabetes.

Importantly, Anguzu and colleagues controlled for a range of confounding factors: maternal age, BMI, race/ethnicity, marital status, education, insurance, family income, contraception use, and history of sexually transmitted infections, yet the association still remained strong, with an adjusted odds ratio of 1.49 (95% CI, 1.26 - 1.76).

"The implications of our study are that perinatal complications...may be reduced by lowering the number of short interpregnancy intervals in this population by effective contraceptive use," said Anguzu.

He concluded that there is a need to optimize maternal health prior to subsequent pregnancies by lengthening the interpregnancy interval to 18 months and longer.

Anguzu and Loeken have reported no relevant financial relationships.

ADA 2020 Scientific Sessions. Presented June 14, 2020. Abstract 192-OR.

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