Table 2.
Relative risks (95% Confidence Intervals) of current newborn outcomes by changes in diabetic status between pregnancies in the NICHD Consecutive Pregnancy Study (N=62013).
| GDM in previous pregnancy | GDM in current pregnancy | GDM in previous & current pregnancy† | DM in current pregnancy | GDM in previous & DM in current pregnancy† | DM in previous & current pregnancy | |
|---|---|---|---|---|---|---|
|
| ||||||
| Current Newborn Outcomes | ||||||
|
|
||||||
| LGA | ||||||
| Unadjusted | 1.24 (1.08-1.43) | 1.73 (1.54-1.95) | 2.15 (1.91-2.42) | 2.21 (1.83-2.66) | 2.74 (2.30-3.26) | 2.69 (2.36-3.06) |
| Adjusted | 1.20 (1.05-1.38) | 1.46 (1.30-1.65) | 1.76 (1.56-1.98) | 1.84 (1.53-2.21) | 2.21 (1.86-2.63) | 2.18 (1.91-2.49) |
| Macrosomia | ||||||
| Unadjusted | 0.95 (0.60-1.50) | 1.55 (1.32-1.81) | 1.84 (1.56-2.16) | 1.07 (0.66-1.74) | 2.25 (1.74-2.91) | 1.78 (1.47-2.15) |
| Adjusted* | 0.84 (0.54-1.31) | 1.27 (1.09-1.49) | 1.50 (1.27-1.77) | 0.88 (0.54-1.43) | 1.82 (1.41-2.36) | 1.45 (1.20-1.76) |
| Jaundice | ||||||
| Unadjusted | 1.08 (0.96-1.21) | 1.18 (1.08-1.30) | 1.27 (1.15-1.41) | 1.27 (1.07-1.51) | 1.37 (1.16-1.61) | 1.56 (1.40-1.75) |
| Adjusted | 1.07 (0.95-1.20) | 1.11 (1.01-1.22) | 1.19 (1.07-1.31) | 1.14 (0.96-1.35) | 1.21 (1.03-1.42) | 1.47 (1.31-1.64) |
| Shoulder dystocia¥ | ||||||
| Unadjusted | 1.55 (1.11-2.17)║ | 1.48 (1.10-2.00) | 2.30 (1.71-3.10) | 2.23 (1.39-3.56) | 3.46 (2.22-5.40) | 2.34 (1.61-3.42) |
| Adjusted‡ | 1.53 (1.10-2.13)║ | 1.30 (0.96-1.76) | 1.98 (1.46-2.70) | 1.91 (1.20-3.04) | 2.92 (1.85-4.59) | 2.14 (1.46-3.13) |
| Congenital anomaly | ||||||
| Unadjusted | 0.79 (0.60-1.04) | 1.31 (1.07-1.61) | 1.04 (0.81-1.33) | 1.60 (1.09-2.34) | 1.26 (0.86-1.85) | 1.71 (1.34-2.18) |
| Adjusted | 0.76 (0.58-1.01) | 1.24 (1.01-1.53) | 0.95 (0.74-1.22) | 1.47 (1.00-2.17) | 1.13 (0.76-1.67) | 1.52 (1.18-1.96) |
| Preterm birth <37 (w) | ||||||
| Unadjusted | 1.21 (1.01-1.46) | 1.43 (1.23-1.66) | 1.73 (1.49-2.02) | 1.60 (1.23-2.06) | 1.94 (1.52-2.47) | 2.70 (2.32-3.13) |
| Adjusted‡ | 1.21 (1.01-1.46) | 1.38 (1.19-1.61) | 1.68 (1.44-1.96) | 1.47 (1.13-1.91) | 1.79 (1.40-2.28) | 2.46 (2.10-2.87) |
| Spontaneous preterm birth <37 (w) | ||||||
| Unadjusted | 1.36 (1.07-1.73) | 1.14 (0.93-1.40) | 1.56 (1.28-1.90) | 1.11 (0.77-1.60) | 1.51 (1.07-2.14) | 2.08 (1.68-2.57) |
| Adjusted‡ | 1.41 (1.11-1.80) | 1.20 (0.98-1.48) | 1.70 (1.39-2.08) | 1.16 (0.79-1.69) | 1.64 (1.15-2.32) | 2.18 (1.76-2.72) |
| Indicated preterm birth <37 (w) | ||||||
| Unadjusted | 1.00 (0.71-1.41) | 2.50 (1.91-3.27) | 2.51 (1.88-3.35) | 3.70 (2.44-5.62) | 3.70 (2.47-5.57) | 5.11 (3.95-6.62) |
| Adjusted¶ | 0.99 (0.71-1.38) | 1.92 (1.48-2.49) | 1.90 (1.42-2.54) | 2.44 (1.63-3.66) | 2.43 (1.60-3.68) | 3.46 (2.61-4.57) |
| NICU admission | ||||||
| Unadjusted | 1.10 (0.93-1.32) | 1.55 (1.34-1.78) | 1.71 (1.47-1.98) | 1.99 (1.58-2.50) | 2.19 (1.75-2.74) | 2.71 (2.34-3.13) |
| Adjusted‡ | 1.10 (0.92-1.31) | 1.44 (1.25-1.67) | 1.59 (1.36-1.84) | 1.72 (1.37-2.15) | 1.88 (1.50-2.36) | 2.30 (1.99-2.67) |
| RDS | ||||||
| Unadjusted | 0.98 (0.73-1.32) | 1.44 (1.13-1.83) | 1.41 (1.10-1.82) | 1.94 (1.31-2.87) | 1.90 (1.30-2.80) | 2.72 (2.16-3.43) |
| Adjusted§ | 0.91 (0.68-1.22) | 1.33 (1.05-1.68) | 1.21 (0.93-1.57) | 1.77 (1.19-2.63) | 1.61 (1.07-2.42) | 2.24 (1.76-2.86) |
DM: diabetes mellitus (type 1 or 2); GDM: gestational diabetes mellitus; LGA: large for gestational age; NICU: neonatal intensive care unit; RDS: respiratory distress syndrome.
RRs and CIs from a modified Poisson regression model fit to each outcome.
Analysis adjusted for study site, maternal age (<20, 20-29, 30-34, ≥35 years), ethnicity/race (non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander, and other), parity defined as number of previous live births (1, 2, ≥3), inter-pregnancy interval defined as time elapsed between the woman's last delivery date and the date of the last menstrual period for the current pregnancy (0-5, 6-11, 12-17, 18-23, 24-59, ≥60 months), pre-pregnancy BMI (<18.5, 18.5-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, ≥40 kg/m2), and pregnancy smoking status (yes/no).
One study site excluded due to sample size limitations.
Data restricted to women with vaginal deliveries.
Two study sites excluded due to sample size limitations.
Four study sites excluded due to sample size limitations.
Three study sites excluded due to sample size limitations.
Risk estimates for shoulder dystocia in the GDM in previous pregnancy group were unreliable due to small sample size.
Risk estimates for all the newborn outcomes (except for macrosomia) for exposure group GDM in previous pregnancy & GDM in current pregnancy and for exposure group GDM in previous pregnancy & DM in current pregnancy estimated through an additive term GDM in previous pregnancy + GDM in current pregnancy and GDM in previous pregnancy + DM in current pregnancy. For macrosomia, significant interaction term noted for GDM in previous pregnancy × DM in current pregnancy p=0.013, GDM in previous pregnancy × GDM in current pregnancy p=0.33 and risk estimates for these two exposure groups are reported as interaction terms rather than additive terms.