Gestational diabetes and gestational hypertension -
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Results showed that Caesarean section delivery was near 1. Most adverse outcomes increased further in women with preeclampsia or eclampsia.
In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM.
Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care. Hypertensive disorders of pregnancy HDP and gestational diabetes mellitus GDM are common disorders that may contribute to complications in pregnant women and newborns.
Approximately 8. Both disorders are important global public health concerns. A WHO systemic analysis showed that hypertensive disorders accounted for Women with gestational hypertension GHT may progress to preeclampsia and eclampsia with proteinuria, edema, and tonic—clonic seizures after 20 weeks of gestation.
These conditions can trigger acute liver rupture, chronic kidney disease, visual loss, and other maternal complications 8 , 9 , 10 , 11 , It can also pose a higher risk for adverse birth outcomes for the fetus 13 , 14 , 15 , 16 , 17 , A multicenter study in the US found that neonates born to mothers with preeclampsia or GHT are 2.
Women with unmanaged GDM are also at an elevated risk of developing complications during pregnancy, delivery, and the postpartum period 20 , 21 , 22 , 23 , Poor glycemic control increases adverse infant outcomes as well 25 , 26 , 27 , 28 , 29 , 30 , 31 , Pregnant women may also experience both HDP and GDM 33 , 34 , 35 , Women with HDP or those with both HDP and GDM are at elevated risk for subsequent hypertension and DM after delivery However, previous studies have rarely investigated the complications and adverse birth outcomes associated with co-existing GDM and HDP.
Most studies have evaluated pregnant women with only one of these disorders. The presence of both disorders during pregnancy may pose a greater health impact on mothers and infants.
In this study, we used large insurance claims data to investigate risks of adverse obstetric and neonatal outcomes in pregnant women with HDP alone and with both HDP and GDM. We compared one obstetric and 11 adverse neonatal outcomes in these two groups of women, comparing to reference women without HDP and GDM.
We further assessed whether preeclampsia or eclampsia during pregnancy contributed to adverse outcomes. Age distributions were similar among the three study groups, with a mean age of approximately 33 years; The comparison group had slightly less rural residents, but had higher white-collar employees.
Baseline prevalence rates of comorbidities in the three study groups were all less than 0. Twelve-year trend of incidence per of hypertensive disorders of pregnancy HDP and gestational diabetes mellitus GDM in pregnancy women.
The adjusted odds ratios aORs of preterm delivery were 3. Table 3 shows that the C-section delivery rate increased steadily with hypertension status to the highest of The preterm delivery rate was much greater in women with preeclampsia or eclampsia than in women with only GHT and comparisons Eclampsia or preeclampsia also led to higher risks of preterm delivery, small gestation age SGA , patent ductus arteriosus PDA , patent foramen oval PFO ASD , RDS and neonatal hypoglycemia.
Large differences existed for SGA rates with aORs of It is well known that pregnant women with HDP or GDM are at elevated risks of subsequent adverse maternal and neonatal health conditions.
Our study showed that HDP is associated with increased C-section delivery with higher preterm delivery and 9 adverse neonatal outcomes than comparisons without HDP. The incidence of HDP in our study was 2. The recent Canadian statistics showed that hypertension affected approximately 7.
Another recent study analyzed the national data of China and found a HDP rate of 3. Our study revealed that 4. The presence of both HDP and GDM during pregnancy posed greater risks of adverse neonatal outcomes than the presence of HDP alone.
The effect of HDP in pregnant women varies among populations. A recent cross-sectional study based on 3,, women with a live birth delivery among the US states found HDP affecting 4. The risk of developing HDP in our study population might not higher than other population 1 , 2 , 3 , Our study found the preterm delivery in women with HDP was more than threefold higher than comparisons.
An earlier US study showed that the adjusted relative risk of preterm delivery in women with HDP was 1. In our study, the highest incidence among other adverse neonatal outcomes in HDP women was jaundice, followed by SGA and RDS, with few cases of LGA.
However, the estimated relative risk was the highest for RDS with an aOR of 6. The risk is higher than the finding in a US nest case—control study within the Calcium for Preeclampsia Prevention trial, with an aOR of 2. For premature infants, the RDS is a common cause of respiratory failure.
This is due to insufficient production of pulmonary surfactant and the immature structure of the lung Previous studies found the impact of preeclampsia on RDS conflicting 41 , 42 , 43 , 44 , However, we are unable to conclude the impact of HTN on RDS because there is no data on antenatal corticosteroid use.
Pregnant women with GDM are known at a higher risk of having newborns of LGA. A Swedish cohort study found an OR of 3.
This study did not evaluate LGA and SGA for women with both HDP and GDM. We note in our study that there were more neonatal SGA than LGA However, the aOR of LGA was much greater than that of SGA The corresponding aORs reduced to It seems hypertension may interact with diabetes exerting increased risk of adverse neonatal outcomes in pregnant women.
Infants born to pregnant women in the HDP group with preeclampsia or eclampsia developed had the highest SGA rates, with very low rate of LGA. The OR of giving birth to a LGA baby increased further to This is an exceptional finding has not been reported previously 22 , 42 , 44 , A recent study evaluating 30, pregnancies in Ontario, Canada, also associated pre-pregnancy diabetes with increased risk of LGA with an adjusted relative risk of However, the absolute rate of LGA was smaller in our study than in the Ontario study 2.
Studies have associated GDM and hypertensive disorders with congenital defects, including congenital heart defects 47 , 48 , 49 , 50 , particularly in women with preterm preeclampsia 51 , 52 , A meta-analysis based on 15 cohort studies found a relative risk of 1.
A Chinese study found that gestational diabetes is one of risk factors associated with the development of congenital heart disease based on the data of 90, infants A Demark study with 1,, singleton pregnancies found a greater risk of offspring congenital heart defects in women with early preterm preeclampsia than in women with late preterm preeclampsia OR 7.
However, we are unable to assess whether these neonatal abnormalities diagnosed were congenital defects without further follow up evaluation for these children. PFO and ASD are likely linked to prematurity. But, we found that VSD was the only adverse birth outcome of congenital defect presented in the 3 study groups ranging from 0.
Our study also found a high risk of neonatal hypoglycemia with an aOR of The development of neonatal hypoglycemia might be influenced by the early gestational age at delivery. Managing GDM by tight glycemic control during pregnancy is essential to effectively reduce the abnormalities.
A secondary analysis from the North American Hyperglycemia and Adverse Pregnancy Outcome Study also found that women with GDM were at a 2. Although this study was strengthened by the use of the large insurance claims database, there were several limitations.
First, information on body mass index, lifestyle of drinking, smoking and diet, and family health history was unavailable to adjust for these potential confounders in data analyses.
However, the impact from some of these factors might be minor because pregnant women are more likely to avoid unhealthy behaviors. Smoking and drinking are rare habits in women in Taiwan and obesity is not prevalent as well. The study results might not be generalizable to non-Chinese populations and populations with higher rates of obesity.
Third, information on the severity of disorders during pregnancy was unavailable for analyses. Misclassification would tend to increase the observed magnitude associated with severe conditions. However, it is unlikely that we have misclassified women with preeclampsia or eclampsia, as these conditions made a strong impact that had not been previously reported.
Fourth, we established groups of women with HDP and women with both HDP and GDM, without a group of GDM. Therefore, the impact associated with GDM alone or with the severity of GDM could not be evaluated in this study, but we were able to subdivide hypertensive disorders of pregnancy into pregnancy-induced hypertension and preeclampsia or eclampsia.
Fifth, a high incidence of preterm delivery was observed in this study. However, we were unable to identify the spontaneous preterm delivery to further evaluate the attribution to the neonatal outcomes.
Because of the progressive nature of HDP and GDM, early delivery is usually recommended to minimize the maternal morbidity and mortality, especially for the more severe presentations of HDP or GDM, such as preeclampsia and eclampsia. Our findings underscore the need for prenatal care with careful attention to pregnant women with HDP, particularly to women with both HDP and GDM.
Obstetricians may need to screen for fetal abnormalities in pregnant women with these disorders, particularly in those with preeclampsia or eclampsia.
It is important to detect and treat HDP and GDM early to reduce obstetrical complications and adverse neonatal outcomes, tight glycemic control and hypertension control are prudent. The Department of Health Insurance in Taiwan is a government-managed system established in through integration of 11 public insurance programs to create a universal insurance system, which is compulsory for all residents.
The National Health Research Institutes NHRI of Taiwan established several data files of reimbursement claims available for research at the inception of For this study, we aimed to investigate the neonatal outcomes for women with a singleton pregnancy at their first birth.
To minimize the inclusion of multiple pregnancies and multiple births, we used the whole population claims data for the period of — To ensure the privacy of the participants, all the data were linked with surrogate identifications processed by NHRI before releasing to researchers.
Information on patient demographic status and health care received were available. Diseases and other health care events were coded using the International Classification of Diseases, Ninth Revision, Clinical Modification ICDCM.
The use of insurance claim data was approved by the Research Ethics Committee of China Medical University and Hospital, Taichung, Taiwan CMUHREC We adhered to the principles in the Declaration of Helsinki in this study.
Informed consent of patients was not required due to the retrospective design of the study and the use of scrambled data. Of these women 65, women had HDP ICDCM The date of HDP diagnosis was defined as the index date.
We exclude those with HDP diagnosed before the year of ; those with a history of diabetes, GDM and hypertension history ICDCM , Women with multifetal gestations were also excluded. Of the remaining 42, women with HDP were eligible for this study. For each patient, we examined normal delivery and Cesarean section ICD-9 code operation 74 , and 11 adverse neonatal outcomes from the birth records, including preterm delivery ICD-9 code: and The demographic data file provided information on age 16—29, 30—34, 35—39, and 40—45 years , urbanization level, and occupation white-collar, blue-collar, and others.
We categorized all residential areas into five urbanization levels from the highest urbanized level as 1 to the lowest level as 5. We also searched for comorbidities that were potentially linked to obstetric birth outcomes including stroke ICDCM — , heart failure ICDCM , ischemic heart disease ICDCM — , renal disease ICDCM — , placental abruption ICDCM All baseline comorbidities were defined before the index date.
We used SAS software version 9. Analysis of variance ANOVA was used to examine differences of mean ages among the three groups.
The aOR was estimated after controlling for age, urbanization level and occupation, and significant comorbidities at the baseline.
We further calculated the aOR of each birth event associated with GHT, preeclampsia and eclampsia ICDCM The data that support the findings of this study were obtained from National Health Insurance Research database NHIRD of the Ministry of Health and Welfare, established by the National Health Research Institutes of Taiwan.
The Ministry of Health and Welfare approved our use of the data. Any researcher interested in accessing this dataset can submit an application to the Ministry of Health and Welfare requesting access.
We are not eligible to duplicate and disseminate the database. For further access to the database, please contact the Ministry of Health and Welfare Email: stcarolwu mohw. tw for further assistance. Taiwan Ministry of Health and Welfare Address: Zhongxiao E.
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The obesity epidemic in gestationwl Womens fitness supplements States and other countries has contributed gestwtional an increase in the rates of gestational Gestational diabetes and gestational hypertension and hypertension. In hypertwnsion past, it was Functional movement exercises that most cases of gestational diabetes and hypertension would resolve after completion of pregnancy. In this issue of the JournalPace et al. Am J Epidemiol. A new generation of epidemiology studies using the evolving new technologies and genetics host susceptibility studies are needed to improve our understanding of the etiology of gestational diabetes and hypertension.Video
Gestational Diabetes in Pregnancy: Diagnosis, Treatment, and New Technology - Mass General Brigham Gestational diabetes is diabetes diagnosed for the hhypertension time during pregnancy gestation. Like other types of diabetes, gestational diabetes affects Gdstational your cells use sugar Gestational diabetes and gestational hypertension. Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. While any pregnancy complication is concerning, there's good news. During pregnancy you can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can keep you and your baby healthy and prevent a difficult delivery.
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