Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p < 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p < 0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p < 0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p < 0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p < 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p = 0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p = 0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p = 0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78-1.97), gestational hypertension (95%CI:0.14-1.41), preeclampsia (95%CI:0.96-2.99), gestational diabetes (95%CI:0.30-1.01), preterm delivery (95%CI:0.74-1.91), preterm premature rupture of membranes (95%CI:0.17-2.82), operative vaginal delivery (95%CI: 0.23-1.19), small for gestational age neonates (95%CI:0.27-2.02) or intra-uterine fetal demise (95%CI:0.13-6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number not applicable

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P–646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Human Reproduction ◽

10.1093/humrep/deab130.645 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Feferkorn ◽

A Badeghiesh ◽

H Baghlaf ◽

M Dahan

Keyword(s):

Gestational Diabetes ◽

Maternal Death ◽

Pregnancy Outcomes ◽

Post Partum ◽

Population Based ◽

Neonatal Outcomes ◽

Pituitary Hormone ◽

Population Based Study ◽

Post Partum Hemorrhage

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p < 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p<0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p<0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p<0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p< 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p=0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p=0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p=0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78–1.97), gestational hypertension (95%CI:0.14–1.41), preeclampsia (95%CI:0.96–2.99), gestational diabetes (95%CI:0.30–1.01), preterm delivery (95%CI:0.74–1.91), preterm premature rupture of membranes (95%CI:0.17–2.82), operative vaginal delivery (95%CI:0.23–1.19), small for gestational age neonates (95%CI:0.27–2.02) or intra-uterine fetal demise (95%CI:0.13–6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings: Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number Not applicable

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Elevated fasting vs post‐load glucose levels and pregnancy outcomes in gestational diabetes: a population‐based study

Diabetic Medicine ◽

10.1111/dme.14173 ◽

2019 ◽

Vol 37 (1) ◽

pp. 114-122 ◽

Cited By ~ 3

Author(s):

E. A. Ryan ◽

A. Savu ◽

R. O. Yeung ◽

L. E. Moore ◽

S. L. Bowker ◽

...

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Population Based Study ◽

Glucose Levels

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Effects of Prepregnancy Body Mass Index, Weight Gain, and Gestational Diabetes Mellitus on Pregnancy Outcomes: A Population-Based Study in Xiamen, China, 2011–2018

Annals of Nutrition and Metabolism ◽

10.1159/000501710 ◽

2019 ◽

Vol 75 (1) ◽

pp. 31-38 ◽

Cited By ~ 3

Author(s):

Wei-juan Su ◽

Yin-ling Chen ◽

Pei-ying Huang ◽

Xiu-lin Shi ◽

Fang-fang Yan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Weight Gain ◽

Preterm Birth ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnancy Outcomes ◽

Population Based ◽

Population Based Study ◽

Prepregnancy Body Mass Index

Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy.

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