title: Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment.
abstract: OBJECTIVE
  Recent guidelines recommend testing at <24 weeks of gestation for maternal dysglycemia in "high-risk" women. Evidence to support the early identification and treatment of gestational diabetes mellitus (GDM) is, however, limited. We examined the prevalence, clinical characteristics, and pregnancy outcomes of high-risk women with GDM diagnosed at <24 weeks of gestation (early GDM) and those with pre-existing diabetes compared with GDM diagnosed at ≥24 weeks of gestation, in a large treated multiethnic cohort.
  
  
  METHODS
  Outcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at <12 weeks of gestation (n = 68), at 12-23 weeks of gestation (n = 1,247), or at ≥24 weeks of gestation (n = 3,493).
  
  
  RESULTS
  Hypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at <12 weeks of gestation were comparable to rates seen in women with pre-existing diabetes.
  
  
  CONCLUSIONS
  Despite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia aswe6150@uni.sydney.edu.au.
authors.forename: Arianne N
authors.identifier: http://orcid.org/0000-0001-6843-6247
authors.initials: AN
authors.lastname: Sweeting
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Glynis P
authors.initials: GP
authors.lastname: Ross
authors.affiliation: Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Hyett
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Lynda
authors.initials: L
authors.lastname: Molyneaux
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Constantino
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Anna Jane
authors.initials: AJ
authors.lastname: Harding
authors.affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jencia
authors.initials: J
authors.lastname: Wong
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose; D002585:Cesarean Section; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology
chemical_list: D001786:Blood Glucose