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The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

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Abstract

Aims

To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk.

Methods

Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM.

Results

Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59–3.87), large for gestational age (OR 3.99, 95% CI 2.40–6.63), fetal malformation (OR 2.66, 95% CI 1.00–7.18), and respiratory distress (OR 4.33, 95% CI 1.33–14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00–2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04–3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21–2.33 for obese; OR 1.38 95% CI 1.03–1.87 for overweight).

Conclusions

A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.

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Acknowledgements

The authors want to thank all the participating local study investigators. We thank the Italian Diabetes and Pregnancy AMD-SID study group for its support.

Author information

Authors and Affiliations

  1. SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy

    Basilio Pintaudi & Matteo Bonomo

  2. Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy

    Raffaella Fresa

  3. Diabetology, Colli-ULSS16, Padua, Italy

    Mariagrazia Dalfrà

  4. Papa Giovanni XXIII Hospital, Bergamo, Italy

    Alessandro Roberto Dodesini

  5. Department of Medicine and Aging, D’Annunzio University, Chieti-Pescara, Italy

    Ester Vitacolonna

  6. Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy

    Andrea Tumminia & Laura Sciacca

  7. Diabetes Unit, Usl Nord Ovest Toscana, Lucca, Italy

    Cristina Lencioni

  8. SSD Diabetology, University Hospital, Foggia, Italy

    Teresa Marcone

  9. COREsearch, Pescara, Italy

    Giuseppe Lucisano & Antonio Nicolucci

  10. S. Andrea Hospital, Sapienza University, Rome, Italy

    Angela Napoli

Authors
  1. Basilio Pintaudi
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  2. Raffaella Fresa
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  3. Mariagrazia Dalfrà
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  11. Antonio Nicolucci
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  13. Angela Napoli
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Consortia

STRONG Study Collaborators

  • Angela Napoli
  • , Olimpia Bitterman
  • , Camilla Festa
  • , Matteo Bonomo
  • , Basilio Pintaudi
  • , Elena Cimino
  • , Elena Mion
  • , Teresa Marcone
  • , Cristina Lencioni
  • , Graziano Di Cianni
  • , Laura Sciacca
  • , Andrea Tumminia
  • , Agostino Milluzzo
  • , Ester Vitacolonna
  • , Federica Fraticelli
  • , Livia Cavuto
  • , Alessandro Roberto Dodesini
  • , Elena Ciriello
  • , Mariagrazia Dalfrà
  • , Annunziata Lapolla
  • , Raffaella Fresa
  • , Aurora Grassi
  • , Paolo Limone
  • , Annamaria Nuzzi
  • , Andi Masha
  • , Laura Grimaldi
  • , Sara Biglino
  • , Egle Ansaldi
  • , Maurizia Battezzati
  • , Giancarla Meregalli
  • , Valentina De Mori
  • , Denise Berzi
  • , Antonio Bossi
  • , Viviana Baggi
  • , Elisabetta Lovati
  • , Lara Quarleri
  • , Tiziana Romanelli
  • , Silvia Clementi
  • , Ilaria Nicolao
  • ,  Francesca Zambotti
  • , Simonetta Lombardi
  • , Silvana Costa
  • , Chiara Tommasi
  • , Silvia Rancan
  • , Giovanna Lisato
  • , Paola Bordon
  • , Daniela Turazzi
  • , Francesco Mollo
  • , Franco Grimaldi
  • , Laura Tonutti
  • , Sandra Agus
  • , Maria Rosaria Falivene
  • , Giorgio Versari
  • , Laura Corsi
  • , Maria Delucchi
  • , Luisa Ratto
  • , Maria Grazia Magotti
  • , Tiziana Frusca
  • , Silvia Haddoub
  • , Alice Suprani
  • , Mary Mori
  • , Maria Grazia Vita
  • , Nicolina Di Biase
  • , Alessandra Bertolotto
  • , Aragona Michele
  • , Bianchi Cristina
  • , Emilia Lacaria
  • , Elisa Guarino
  • , Federica Monaci
  • , Francesco Dotta
  • , Elisabetta Torlone
  • , Carlo Lalli
  • , Chiara di Loreto
  • , Maura Scarponi
  • , Angela Del Prete
  • , Sergio Leotta
  • , Iolanda Coletta
  • , Santina Abbruzzese
  • , Valeria Montani
  • , Emanuela Cannarsa
  • , Pierpaolo Contini
  • , Raffaella Vero
  • , Rosa Oliverio
  • , Marina Scavini
  • , Nicoletta Dozio
  • , Maria Pia Imbergamo
  • , Renzo Cordera
  • , Laura Affinito
  • , Davide Maggi
  • , Caterina Bordone
  • , Elena Fochesato
  • , Alessandra Pissarelli
  • , Eros Libera
  • , Susanna Morano
  • , Tiziana Filardi
  •  & Mara Fallarino

Contributions

BP is the guarantor for the study. He had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Substantial contributions to conception and design, acquisition of data or analysis and interpretation of data: GL, RF, MD, ARD, EV, LS, CL, TM, AN, MB, AT, AN, BP. Drafting of the manuscript: BP, AN. Final approval of the version to be published: BP, RF, MD, ARD, EV, AT, LS, CL, TM, GL, AN, MB, AN. BP (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Corresponding author

Correspondence to Basilio Pintaudi.

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Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Additional information

Managed by Antonio Secchi.

The members of the STRONG Study Collaborators are listed in Supplementary Appendix.

Electronic supplementary material

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Supplementary material 1 (DOCX 19 KB)

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Pintaudi, B., Fresa, R., Dalfrà, M. et al. The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study. Acta Diabetol 55, 1261–1273 (2018). https://doi.org/10.1007/s00592-018-1208-x

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  • DOI: https://doi.org/10.1007/s00592-018-1208-x

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