Effect of Overt Diabetes and Gestational Diabetes Mellitus on Pregnancy Outcomes and Progression.

Background/purpose: To study the clinical characteristics, outcomes, and the incidence of postpartum diabetes in women with overt diabetes and GDM.

Methods: This prospective cohort observational study was done on women with GDM diagnosed after the first trimester, attending the tertiary care hospitals for 2.3 years. Comparison of clinical variables and maternal and neonatal outcomes were recorded in women with overt diabetes and GDM. The postpartum glycemic status was determined at 1 and 6 months.

Results: There were 32(17.9%) women with overt diabetes and 146(82.1%) women with GDM. Women with overt diabetes were older, had a higher frequency of pre-pregnancy and maternal obesity, family history of diabetes, previous history of GDM, polycystic ovarian syndrome (PCOS), signs of insulin resistance, and need for insulin treatment than women with GDM. The prevalence of gestational hypertension and frequency of spontaneous abortion and large for gestational age (LGA) neonates were significantly higher in women with overt diabetes than in GDM, despite comparable glycemic goals. Postpartum diabetes at 1 and 6 months was significantly higher in women with overt diabetes than in those with GDM.

Conclusion: It is critical to identify women with overt diabetes in pregnancy because of increased risk of adverse maternal and neonatal outcomes, and rapid progression to postpartum diabetes, despite achieving optimal glycemic goals.