title: Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012.
abstract: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.
  
  
  
  All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.
  
  
  
  The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).
  
  
  
  GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.
authors.affiliation: Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Billionnet
authors.affiliation: Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, APHP, Paris, France.|Sorbonne University, UPMC Univ Paris 06, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Mitanchez
authors.affiliation: Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.affiliation: Sorbonne University, UPMC Univ Paris 06, Paris, France.|Department of Obstetrics and Gynaecology, Groupe Hospitalier Pitié-Salpêtrière, APHP CNRS UMR 7222, Inserm U1150, Paris, France.
authors.forename: Jacky
authors.initials: J
authors.lastname: Nizard
authors.affiliation: Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: Sorbonne University, UPMC Univ Paris 06, Paris, France.|Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.|Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Hartemann
authors.affiliation: Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France. sophie.jacqueminet@aphp.fr.|Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France. sophie.jacqueminet@aphp.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacqueminet
mesh_terms: D000465:Algorithms; D001724:Birth Weight / Q000187:drug effects; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D016640:Diabetes, Gestational / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Cardiac malformation; Gestational diabetes mellitus; Macrosomia; Perinatal death; Pre-eclampsia; Preterm