Pregnancy outcomes in women aged 35 years or older with gestational diabetes - a registry-based study in Finland.
OBJECTIVE
To compare pregnancy outcomes of women ≥ 35 years to women <35 years with and without gestational diabetes.


METHODS
The data include 230,003 women <35 years and 53,321 women ≥ 35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28-31 and 32-36 weeks' gestation), Apgar scores <7 at 5 min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA).


RESULTS
In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30-1.88), admission to the NICU (OR 3.30, CI 2.94-3.69) and shoulder dystocia (OR 2.12, CI 1.05-4.30) were highest in insulin-treated women ≥ 35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73-3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant.


CONCLUSIONS
GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.
a Department of Nursing Science , University of Eastern Finland , Kuopio , Finland .
Reeta
R
Lamminpää
b Kuopio University Hospital, University of Eastern Finland , Kuopio , Finland .
Katri
K
Vehviläinen-Julkunen
c National Institute for Health and Welfare (THL) , Helsinki , Finland .|d Nordic School for Public Health , Gothenburg , Sweden .
Mika
M
Gissler
b Kuopio University Hospital, University of Eastern Finland , Kuopio , Finland .
Tuomas
T
Selander
e Department of Obstetrics and Gynaecology , Kuopio University Hospital, University of Eastern Finland , Kuopio , Finland , and.|f Helsinki University Central Hospital , Helsinki , Finland.
Seppo
S
Heinonen
D000328:Adult; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012042:Registries
Advanced maternal age; birth outcomes; diet-treated GDM; insulin-treated GDM; normal glucose tolerance; register-based study