Gestational diabetes and stillbirth

by Claudia Ravaldi

What happens when gestational diabetes is not recognized and (adequately) treated?

Dr. Avagliano describes a recent English work and underlines the importance of correct blood glucose monitoring to reduce the risk of stillbirth.

Commentary to T Stacey, PWG Tennant, LME McCowan, EA Mitchell, Budd, M Li, JMD Thompson, B Martin, D Roberts, AEP Heazel. Gestational diabetes and the risk of late stillbirth: a case – control study from England, UK. BJOG 2019; https://doi.org/10.1111/1471-0528.15659 .

The recent work by Stacey and collaborators evaluated the effect of gestational diabetes on the risk of presenting with late intrauterine fetal death.

The study involved a large population of the United Kingdom, involving more than 1000 women, of which about 280 with pregnancy resulting in intrauterine fetal death and about 730 controls, ie women with physiological pregnancy.

The study analysis evaluated the rate of intrauterine death in physiological women without gestational diabetes, in women diagnosed with gestational diabetes, and in women with anamnestic and clinical characteristics that made them at risk for gestational diabetes but who were not screened. , that is, women who did not carry out the oral glucose load curve and therefore they were not diagnosed with diabetes, despite having it .

The results of the study showed that women at risk for gestational diabetes but not screened had an approximately 50% higher risk of intrauterine death than physiological women.

Conversely, screened (and therefore diagnosed as diabetic) at risk for diabetes showed a risk of intrauterine death comparable to that of women without risk factors.

The authors’ final conclusions were therefore that screening for diabetes and diagnosing gestational diabetes mitigates the risk of intrauterine fetal death . Not diagnosing gestational diabetes, on the other hand, leaves women with high blood sugar at risk of incurring an intrauterine fetal death that would otherwise be potentially avoidable if the correct diagnosis and treatment of the disease were implemented.

The results of this study confirm what is known from previous epidemiological studies and are in line with what emerged a few years ago also from an Italian study.

The study, involving several obstetric centers in our area, in fact demonstrated how the correct diagnosis and treatment of gestational diabetes throughout pregnancy allows to obtain an obstetric outcome similar to the general non-diabetic population [Lapolla et al. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2009; 145: 149-153].

The diagnosis of gestational diabetes allows in fact to implement an adequate therapeutic approach to gestation and adequate monitoring.

The attention and diligence in the relevance to the therapy (generally dietetic) allow to optimize the maternal glycemic values by regulating the transplacental passage of nutrients. Fetal oxygenation is also indirectly linked to this.

Proper clinical management of gestational diabetes can therefore have a beneficial effect on the health of the baby.

We can therefore summarize the results of the studies with the concept that “the problem is not having diabetes but not knowing that you have it” .

The diagnosis and correct clinical management of gestational diabetes allow in fact to reduce the risk of intrauterine fetal death related to maternal-fetal glycemic alterations.

Laura Avagliano

Surgeon specialist in Gynecology and Obstetrics.
Freelance Medical Center Andromeda, Milan
Adjunct Professor at the University of Milan

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