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Temporal variations in maternal treatment requirements and early neonatal outcomes in patients with gestational diabetes.

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Fox, Rachel A 
Patient, Charlotte J 
Aiken, Abigail R 


AIMS: There is seasonal variation in the incidence of gestational diabetes (GDM) and delivery outcomes of affected patients. We assessed whether there was also evidence of temporal variation in maternal treatment requirements and early neonatal outcomes. METHODS: We performed a retrospective analysis of women diagnosed with GDM (75 g oral glucose tolerance test, 0 h ≥ 5.1; 1 h ≥ 10.0; 2 h ≥ 8.5 mmol/L) in a UK tertiary obstetric centre (2015-2019) with a singleton infant. Data regarding demographic characteristics, total insulin requirements and neonatal outcomes were extracted from contemporaneous electronic medical records. Linear/logistic regression models using month of the year as a predictor of outcomes were used to assess annual variation. RESULTS: In all, 791 women (50.6% receiving pharmacological treatment) and 790 neonates were included. The likelihood of requiring insulin treatment was highest in November (p < 0.05). The average total daily insulin dose was higher at peak (January) compared to average by 19 units/day (p < 0.05). There was no temporal variation in neonatal intensive care admission, or neonatal capillary blood glucose. However, rates of neonatal hypoglycaemia (defined as <2.6 mmol/L) were highest in December (40% above average; p < 0.05). CONCLUSIONS: Women with GDM diagnosed in winter are more likely to require insulin treatment and to require higher insulin doses. Neonates born to winter-diagnosed mothers had a corresponding increased risk of neonatal hypoglycaemia. Maternal treatment requirements and neonatal outcomes of GDM vary significantly throughout the year, even in a relatively temperate climate.



birthweight, climate, gestational diabetes, obstetric outcomes, pregnancy, seasonality, temporality, Adult, Diabetes, Gestational, Female, Glucose Tolerance Test, Humans, Hypoglycemic Agents, Incidence, Infant, Newborn, Infant, Newborn, Diseases, Insulin, Male, Pregnancy, Pregnancy Outcome, Retrospective Studies, United Kingdom

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Diabet Med

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All rights reserved
Diabetes UK (17/0005712)
Novo Nordisk Foundation (NNF19SA058974)
European Foundation for the Study of Diabetes (EFSD) (NNF19SA058974)
MRC (MR/T016701/1)
CLM is supported by the Diabetes UK Harry Keen Intermediate Clinical Fellowship (DUK-HKF 17/0005712) and the EFSD-Novo Nordisk Foundation Future Leader’s Award (NNF19SA058974). CEA is supported by an Action Medical Research grant (GN2788) and by a Medical Research Council New Investigator Grant (MR/T016701/1). This work was supported by the NIHR Cambridge Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.