Abstract
Aims/hypothesis
Controversy exists over whether gestational diabetes increases the risk of stillbirth. The aim of this review was to examine the association between gestational diabetes and stillbirth.
Methods
We performed searches of the published literature to May 2021. Study selection and data extraction were performed in duplicate by independent reviewers. Meta-analyses of summary measures were conducted using random-effect models for cohort and case–control studies separately. The study protocol was registered in PROSPERO (registration ID CRD42020166939).
Results
From 9981 citations, 419 were identified for full-text review and 73 met inclusion criteria (n = 70,292,090). There was no significant association between gestational diabetes and stillbirth in cohort studies (pooled OR 1.04 [95% CI 0.90, 1.21]; I2 86.1%) or in case–control studies (pooled OR 1.57 [95% CI 0.83, 2.98]; I2 94.8%). Gestational diabetes was associated with lower odds of stillbirth among cohort studies presenting with an adjusted OR (pooled OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%). Stratified analyses by stillbirth ≥28 weeks’ gestation, studies published prior to 2013 and studies identified as low quality demonstrated a significantly higher odds of stillbirth in meta-regression (p = 0.016, 0.023 and 0.005, respectively). Egger’s test for all included cohort studies (p = 0.018) suggests publication bias for the main meta-analysis.
Conclusions/interpretation
Given the substantial heterogeneity across studies, there are insufficient data to define the relationship between stillbirth and gestational diabetes adequately. In the main analyes, gestational diabetes was not associated with an increased risk of stillbirth. However, heterogeneity across studies means this finding should be interpreted cautiously.
Graphical abstract
Similar content being viewed by others
Introduction
Gestational diabetes, defined as glucose intolerance with onset or first recognition during pregnancy, is one of the most common medical complications in pregnancy, affecting 6–25% of pregnant women depending on diagnostic criteria used [1,2,3]. The prevalence of gestational diabetes is rising worldwide, in parallel with the obesity epidemic [4]. Gestational diabetes confers an approximate 1.5-fold to threefold higher risk of some adverse neonatal or maternal outcomes, depending on the definition used, although complications such as hypertensive disorders of pregnancy, shoulder dystocia and macrosomia can be reduced by approximately 50% by appropriate treatment during pregnancy [5,6,7,8,9,10,11]. It is well-recognised that pregnancies among women with pre-existing diabetes carry a four- to fivefold increased risk of stillbirth compared with the general obstetric population [12, 13]. However, the literature examining the incidence of stillbirth in women with gestational diabetes has been inconsistent, and many of the previously published studies that suggested an association between gestational diabetes and stillbirth were performed at a time when women with suspected pre-existing overt diabetes were not excluded from the definition of gestational diabetes.
Based on the conflicting data currently available, it remains unclear whether gestational diabetes portends an increased risk of stillbirth. Some, but not all, observational studies have shown that individuals with gestational diabetes are more likely to experience a stillbirth, although this risk does not appear to be as pronounced as that for pregnancies with pre-existing diabetes [14,15,16]. This inconsistency may be influenced by the variability in gestational age cut-off chosen for stillbirth definition in the studies and the range of diagnostic criteria used for gestational diabetes diagnosis. Furthermore, several factors such as obesity, advanced maternal age, excessive gestational weight gain and unrecognised pre-existing diabetes are important confounders of any postulated relationship with gestational diabetes [17,18,19,20]. If present, risk of stillbirth in gestational diabetes might be mitigated by adequate glycaemic control in pregnancy, as well as induction of labour [21].
Despite the discordant evidence and heterogeneity of existing studies, some professional organisations recommend that all pregnant women with gestational diabetes be offered induction of labour between 38 and 40 weeks’ gestation to potentially reduce the risk of stillbirth [22,23,24,25,26]. However, whether gestational diabetes is associated with an increased risk of stillbirth remains largely unknown. To address this knowledge gap, we conducted a systematic review and meta-analysis of observational studies examining the relationship between gestational diabetes and risk of stillbirth.
Methods
A systematic review and meta-analysis was performed as outlined in the registered protocol (PROSPERO registration ID CRD42020166939) [27]. The study was conducted and is reported in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines [28].
Data sources and searches
We developed a search strategy in collaboration with a medical librarian using keywords related to gestational diabetes and pregnancy outcomes, as outlined in electronic supplementary material (ESM) Methods. The search themes were combined using the Boolean term ‘AND’. The search was modified and adapted according to search headings for each database. The search, limited to human studies, was performed in duplicate on 27 January 2020 and was updated on 1 May 2021. The following databases were searched systematically: MEDLINE; EMBASE; Cochrane Database of Systematic Reviews; and Cochrane Central Register of Controlled Trials. The reference lists of the included articles and relevant reviews were examined to identify additional relevant publications for inclusion. Local experts in the field were consulted to ensure no studies had been missed.
Study selection
Studies needed to meet all of the following criteria to be eligible for inclusion in this review: (1) included pregnant individuals; (2) included those with gestational diabetes defined by the investigator-reported definition; (3) included a comparator group of pregnant women without gestational diabetes; (4) reported on the outcome of stillbirth; and (5) were either cohort studies or case–control studies reporting the association between gestational diabetes and the risk of stillbirth. Only studies reporting original data, written in English or French, published in full-text format were included. There was no restriction on time of publication or study setting. We included only languages that our study team was fluent in so we were able to directly evaluate all included studies.
Since stillbirth is a rare outcome and the absence of the event does not enable calculation of a risk estimate, studies reporting no stillbirth occurrence in either or both arms were excluded from this systematic review and meta-analysis [29]. Authors of studies only reporting perinatal mortality data were contacted by e-mail to inquire about stillbirth occurrence specifically, given it comprises part of perinatal mortality data. Studies were excluded if the information was not available.
At each stage, review and identification of studies were performed in duplicate by two independent reviewers (PL and JLB). After removal of duplicates, titles and abstracts of all references retrieved from the initial search were screened to assess eligibility. Next, full-text articles of potentially relevant publications were scrutinised in detail. Inclusion criteria were applied to select eligible articles and reasons for exclusion at the full-text review were documented. Agreement was recorded at each stage and reported as a κ statistic. Disagreements between reviewers were resolved through consensus or by discussion with a third independent reviewer (JMY). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was used to summarise the search and study selection process [30]. If two studies reported data on the same cohort for stillbirth occurrence, only the study with the most complete data was included [31, 32].
Data extraction and quality assessment
From each eligible study, two reviewers independently extracted relevant information, using a standardised data collection form (PL and NM). Any disagreement between reviewers was resolved as outlined above. Data from included studies were extracted for study characteristics including first author name, year of publication, study design, country where the study was conducted, quality of the methods, number of groups, total number of participants, diagnostic criteria used for gestational diabetes, timing of diagnosis and type of population screened. Extracted data elements also included outcomes measures such as stillbirth definition, stillbirth incidence based on the exposure, size of the association (OR or RR) with corresponding 95% CI and factors adjusted for. Individuals’ characteristics, including BMI, age and parity, were extracted. Covidence (Veritas Health Information, Melbourne, VIC, Australia; 2020 and 2021 versions [current version v2655 bf7ee44c]) and Microsoft Excel (Version 16.30; Microsoft Corporation, Redmond, WA, USA) were used for data management.
The methodological quality and potential risk of bias of included studies was assessed by two independent reviewers using the validated Newcastle–Ottawa scale [33]. Studies with a total score of 5 or less were considered as low-quality studies. Studies were awarded full points for comparability if an adjusted estimate, controlling for at least two potential confounders, was specifically reported for stillbirth incidence and/or if cases and controls were matched for multiple factors, including BMI. Any discrepancies were resolved through discussion and if consensus could not be reached, the dispute was resolved with the help of a third reviewer (JMY).
Data synthesis and analysis
Meta-analyses were conducted using random-effect models for cohort and case–control studies separately. Observational studies reporting OR and RR, adjusted or unadjusted or providing the incidence of stillbirth were included in the meta-analysis. Study effect estimates were included using the following hierarchy: (1) study-reported ORs were used when available; (2) we converted RR to OR or calculated the OR when outcome rates were available; (3) if neither of those were possible and an RR was reported, we used RR as equal to OR under the rare disease assumption [34].
The heterogeneity of the studies was quantified using I2 statistics, where I2 > 50% represents moderate and I2 > 75% represents substantial heterogeneity across studies [35]. Publication bias was assessed by visual examination of the funnel plot and/or using Egger’s test as appropriate.
To explore potential sources of heterogeneity, subgroup analyses were carried out according to relevant study characteristics previously extracted. Meta-regression analyses were performed based on our registered protocol and where the number of included studies reporting was high enough. Sensitivity analyses were conducted to evaluate the influence of individual studies on the overall effect by excluding studies one by one and comparing the results in the analysis. Sensitivity analyses were also conducted to assess the effect of adjusted and unadjusted estimates. All statistical analyses were performed using Stata (version 16.0; StataCorp LP, College Station, TX, USA).
Results
From the 9981 citations reviewed for title and abstract, 419 citations were identified for full-text review (Fig. 1). A total of 73 articles (66 cohort studies and seven case–control studies) involving 70,292,090 participants were included. Cohort studies included 69,697,806 participants (66,077,325 control participants and 3,620,481 with gestational diabetes) and case–control studies included 594,284 participants (588,991 live births [controls] and 5293 stillbirths). Of 20 cohort studies reporting perinatal mortality data, specific information about stillbirth occurrence was obtained for three studies [36,37,38], which were included in the analyses. The κ statistic for inter-rater agreement for the original search was 0.56 (95% CI 0.51, 0.60) for the title and abstract review and 0.87 (95% CI 0.82, 0.93) for the full-text review.
Study characteristics
Study characteristics are summarised in Table 1 [6,7,8, 14, 15, 31, 32, 36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94], Table 2 [21, 95,96,97,98,99,100] and ESM Table 1. Study year ranged from 1990 to 2021, and sample size ranged from 80 to 56,610,106 participants. Multiple criteria were used to diagnose gestational diabetes, the most common being the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and Carpenter–Coustan criteria [101, 102].
Quality assessment
Study quality assessment, using the Newcastle–Ottawa scale, is presented in ESM Tables 2 and 3. Most of the studies were rated as low risk of bias for participant selection. Only a small number of studies obtained full points for comparability. The adequacy of follow-up was reported inconsistently, and most cohort studies were thus awarded full points for ascertainment of outcome, presuming participants were followed until delivery, by which time a stillbirth would have occurred. A total of 11 cohort studies obtained a total score of 5 or less and were classified as low quality.
Assessment of publication bias
A funnel plot for the main analysis is presented in ESM Fig. 1. On visual inspection, there was asymmetry in which there is a relative absence of small negative studies. The result of Egger’s test was statistically significant for the main analysis (p = 0.018); this is consistent with the funnel plot and would suggest publication bias.
Association between stillbirth and gestational diabetes
The 66 cohort studies were pooled to evaluate the risk of stillbirth. One study presented stillbirth risk stratified by stillbirth definition (20 vs 28 weeks) [14]. The main meta-analysis was performed, including the 28 weeks’ cohort, and a sensitivity analysis substituting the 20 weeks definition was conducted. The pooled unadjusted weighted OR was 1.04 (95% CI 0.90, 1.21; I2 86.1%), suggesting no significant association between gestational diabetes and stillbirth. The analysis performed including the 20 weeks’ cohort similarly found no association (OR 1.02 [95% CI 0.88, 1.17]; I2 84.7%). These meta-analyses were performed using OR as the effect size, combining OR for 65 studies and RR for one study [15]. A sensitivity analysis was performed excluding the study reporting the RR and showed similar results (OR 1.00 [95% CI 0.87, 1.15]; I2 81.0%). An additional analysis restricted to the 12 cohort studies reporting an adjusted OR or RR was performed and found that gestational diabetes was associated with a lower risk of stillbirth (OR 0.78 [95% CI 0.68, 0.88]; I2 42.7%) (Fig. 3).
A meta-analysis was performed for stillbirth odds using data for the seven case–control studies. The pooled OR was 1.57 (95% CI 0.83, 2.98); I2 94.8%, suggesting that gestational diabetes was not associated with stillbirth (Fig. 4).
Stratified analyses
A stratified analysis was conducted using studies reporting a stillbirth definition by gestational age: the early stillbirth group included studies using a threshold of <28 weeks’ gestation; and the late stillbirth group included studies defining stillbirths using a threshold of 28 weeks’ gestation or beyond (cut-offs 28–37 weeks) (Fig. 5). No significant association was found in the pooled analysis restricted to the 21 studies that included early stillbirth in their definition (OR 0.86 [95% CI 0.69, 1.06]; I2 74.5%). However, when the analysis was restricted to the 11 studies that only included late stillbirths, gestational diabetes was significantly associated with an increased risk of stillbirth (OR 1.27 [95% CI 1.18, 1.37]; I2 0%; meta-regression p = 0.016) (Fig. 2, Table 3). Funnel plots for these analyses are displayed in ESM Figs 2, 3. Visual inspection of the funnel plot for publications using only late stillbirth in the definition (n = 11) reveal there may be evidence of publication bias, although this was not supported by Egger’s test (p = 0.25).
Cohort studies were also analysed according to their year of publication using the median as the threshold: 31 studies published before 2013; and 35 studies published in 2013 or later (ESM Fig. 4). Risk of stillbirth was significantly higher in studies published before 2013 (OR 1.35 [95% CI 1.06, 1.71]; I2 74.1%) compared with 2013 or later (OR 0.86 [95% CI 0.72, 1.04]; I2 86.7%; meta-regression p = 0.023) (Table 3). The funnel plots for these analyses are displayed in ESM Figs 5, 6. Egger’s test was not statistically significant in studies published prior to 2013 (p = 0.34) or after 2013 (p = 0.32).
A total of 14 studies were performed in North America, 18 in Asia, 13 in the Middle East, 14 in Europe, three in Africa, three in Australia and one in Brazil (ESM Fig. 7). With a higher baseline rate of stillbirth in the population [103, 104], a pooled analysis restricted to studies from Africa was conducted and found that gestational diabetes was associated with an increased risk of stillbirth (OR 2.87 [95% CI 1.24, 6.63]; I2 19.8%; meta-regression p = 0.026) (Table 3). No significant association was found for the other study regions.
A stratified analysis by study quality found that there was no increased risk of stillbirth in moderate- to high-quality studies (OR 0.96 [95% CI 0.82, 1.11]; I2 86.8%), but there was an association in low-quality cohort studies (OR 2.57 [95% CI 1.13, 5.82]; I2 82.9%; meta-regression p = 0.005) (Table 3 and ESM Fig. 8). The funnel plots for these analyses are displayed in ESM Figs 9, 10. Egger’s test was not statistically significant for moderate- to high-quality studies (p = 0.10) but did indicate possible publication bias in studies that were scored as low quality (p = 0.002).
There was no significant association between diagnostic criteria used to diagnose gestational diabetes, timing of gestational diabetes screening or screening strategy (population vs risk-factor-based screening) and stillbirth risk (Table 3 and ESM Figs 11–13).
Finally, stratified analyses performed by study design (prospective vs retrospective and hospital-based vs registry-based cohort) found that prospective studies and hospital-based cohort studies were significantly associated with an increased risk of stillbirth (OR 2.27 [95% CI 1.35, 3.84]; I2 62.2% and OR 1.44 [95% CI 1.10, 1.89]; I2 68.1%, respectively [ESM Figs 14, 15]; meta-regression p = 0.001 and p = 0.006, respectively [Table 3]). The funnel plots for these analyses are displayed in ESM Figs 16–19. Egger’s tests for retrospective cohorts (p = 0.17) and prospective cohorts (p = 0.10) were not significant. However, Egger’s test for studies including hospital-based data was significant (p < 0.001), indicating publication bias, but was non-significant for studies using registry-based data (p = 0.58).
Discussion
This meta-analysis found that gestational diabetes was not associated with an increased risk of stillbirth, when pooling 66 cohort studies of more than 69 million participants; however, there was substantial heterogeneity across studies. The sensitivity analyses indicated potential sources of this heterogeneity, including year of publication, definition of stillbirth and study quality. Specifically, we found an increased risk of stillbirth in women with gestational diabetes in studies that limited their definition of stillbirth to those occurring at ≥28 weeks’ gestation, cohort studies published prior to 2013, and low-quality studies. Furthermore, the meta-analysis of seven case–control studies showed no significant association between gestational diabetes and stillbirth; however, given the small number of studies included and substantial heterogeneity, this finding requires cautious interpretation.
Notably, when including only cohort studies that reported estimates adjusted for potential confounders, there was a significantly lower risk of stillbirth in women exposed to gestational diabetes compared with control women. Medical comorbidities, including obesity, and advanced maternal age are not only associated with development of gestational diabetes but are also independent risk factors for stillbirth and may potentially overestimate the association between gestational diabetes and fetal mortality if not accounted for [19, 105]. Another possible explanation for these findings is that gestational diabetes itself is associated with an increased risk of stillbirth but that the true effect is attenuated in the pooled estimate after adjustments for advanced maternal age and obesity due to confounding by indication (i.e. earlier induction of labour for advanced maternal age and/or obesity before the occurrence of stillbirth from gestational diabetes actually underestimate the influence of diabetes on fetal loss). Since many of the studies included in our meta-analysis were not primarily designed to examine stillbirth occurrence, most did not report adjusted estimates for this outcome and limited our pooled analysis. The results of this review require validation in larger prospective studies but if replicated by future research may warrant further reflection about current guidelines recommending delivery of pregnancies complicated by gestational diabetes.
A subgroup analysis restricted to studies that defined stillbirth using a gestational cut-off of 28 weeks or later found that gestational diabetes was associated with an increased risk of stillbirth with absence of statistical heterogeneity (I2 = 0). In contrast, there was no significant association after pooling studies that defined stillbirth using a threshold of less than 28 weeks’ gestation. This sensitivity analysis demonstrates an important potential source of bias in the literature examining the association between gestational diabetes and stillbirth. It reinforces the concept of immortal time bias described by Hutcheon et al. [14], as pregnancies must reach 24–28 weeks’ gestation to be screened for gestational diabetes: the time period between the start of the cohort follow-up, if prior to 24–28 weeks’ gestation and the time at which gestational diabetes is diagnosed is referred to as ‘immortal’. Stillbirths occurring in that time period are not attributable to gestational diabetes since by the nature of its pathophysiology, this type of diabetes is not usually diagnosed until after 24 weeks’ gestation. Including those stillbirths could potentially attenuate the association between gestational diabetes and stillbirth. Including only fetal deaths occurring after the screening window for gestational diabetes allows for more accurate determination of the associated risk of stillbirth. Our study suggests that women with gestational diabetes are more likely to experience a stillbirth after 28 weeks’ gestation than women without this condition. This finding must be interpreted with caution for two reasons. First, the funnel plot for studies including only definitions of late stillbirth indicated possible publication bias. While Egger’s test was not statistically significant, it was likely underpowered for this stratified analysis of only 11 studies. Second, most studies reported unadjusted estimates, and the only two studies that reported an adjusted estimate did not find a significant association [6, 68].
Our meta-analysis found that publication year was associated with stillbirth occurrence, as studies published before 2013 indicated a significantly higher risk of fetal death compared with studies published in or after 2013. One explanation might reside in the improvement of diabetes and prenatal care over the decades, including enhanced recognition of gestational diabetes, more stringent monitoring of glucose levels and increased fetal monitoring [106,107,108,109,110]. Another explanation is that, given older definitions used to diagnose gestational diabetes, earlier studies were more likely to include women with pre-existing diabetes who were undiagnosed prior to pregnancy. Therefore, including these women in analyses of gestational diabetes would inflate the risk of fetal loss because pre-existing diabetes is a strong risk factor for stillbirth. Additionally, diagnostic criteria for gestational diabetes have changed throughout the years and the adoption by many countries of the IADPSG criteria has led to an increase in the prevalence of gestational diabetes and the inclusion of less-severe hyperglycaemia [111, 112]. It is therefore possible that older studies have included women with more-severe dysglycaemia and, subsequently, women truly at higher risk of stillbirth: however, those historical case-definitions of gestational diabetes may no longer represent the contemporary population of pregnant women with this diagnosis [111,112,113,114]. Subgroup analyses stratified by diagnostic criteria, including subgroups of women diagnosed using IADPSG criteria, found no significant association between gestational diabetes and stillbirth. Furthermore, there was no significant between-group difference regarding stillbirth incidence by diagnostic criteria, though we may have been underpowered in the meta-regression to demonstrate significance as approximately half of the studies did not report or use criteria that are widely accepted for the diagnosis of gestational diabetes. These studies were not included in this analysis.
To our knowledge, this study is the first meta-analysis to examine and quantify the relationship between gestational diabetes and stillbirth. With 9981 citations screened for eligibility and a sample size of >70 million women, it provides a comprehensive review of the existing literature and includes studies using contemporary diagnostic criteria for gestational diabetes. Our study is further strengthened by use of a registered protocol and rigorous methodology. However, limitations include the presence of heterogeneity across the published studies, potentially preventing robust conclusions to be drawn. Most studies reported unadjusted data for stillbirth occurrence, which may introduce bias as many important confounders can interfere in the relationship between stillbirth and gestational diabetes. Though we included a large number of studies and women, we still may have lacked power to demonstrate a significant difference in our subgroup analyses. Lastly, a small number of studies reported data on delivery management and timing and on the adequacy of glycaemic control achieved during pregnancy, and, as a result, these pre-specified stratified analyses could not be performed. The degree to which these factors contribute to or prevent stillbirth could therefore not be assessed.
Given the substantial heterogeneity in existing studies, there is inadequate data to clearly identify whether gestational diabetes is associated with an increased risk of stillbirth and findings should be interpreted cautiously. However, our review overall suggests that gestational diabetes does not confer an increased risk of stillbirth. Restricting analyses to studies adjusted for confounders showed a decreased risk of stillbirth with gestational diabetes. The absolute risk of stillbirth with gestational diabetes was increased when including only late stillbirths (after 28 weeks), studies published prior to 2013 and studies of low quality. Although stillbirth is rare, each case is truly devastating for families. Additional high-quality research, particularly examining late stillbirth and adjusting for potential confounders is urgently needed to inform clinical decision making and guide management of women with gestational diabetes to improve perinatal outcomes.
Data availability
Individual participant data are not available as we used study-level data for our meta-analyses. Extracted data are available, on request, from the corresponding author.
Abbreviations
- IADPSG:
-
International Association of Diabetes and Pregnancy Study Groups
References
Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH (2014) Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 103(2):176–185. https://doi.org/10.1016/j.diabres.2013.11.003
Deputy NP, Kim SY, Conrey EJ, Bullard KM (2018) Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth - United States, 2012-2016. MMWR Morb Mortal Wkly Rep 67(43):1201–1207. https://doi.org/10.15585/mmwr.mm6743a2
Sacks DA, Hadden DR, Maresh M et al (2012) Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the hyperglycemia and adverse pregnancy outcome (HAPO) study. Diabetes Care 35(3):526–528. https://doi.org/10.2337/dc11-1641
Chu SY, Callaghan WM, Kim SY et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30(8):2070–2076. https://doi.org/10.2337/dc06-2559a
Billionnet C, Mitanchez D, Weill A et al (2017) Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 60(4):636–644. https://doi.org/10.1007/s00125-017-4206-6
Fadl HE, Ostlund IK, Magnuson AF, Hanson US (2010) Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabet Med 27(4):436–441. https://doi.org/10.1111/j.1464-5491.2010.02978.x
Schmidt MI, Duncan BB, Reichelt AJ et al (2001) Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care 24(7):1151–1155. https://doi.org/10.2337/diacare.24.7.1151
Langer O, Yogev Y, Most O, Xenakis EM (2005) Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 192(4):989–997. https://doi.org/10.1016/j.ajog.2004.11.039
Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L (2013) Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. preventive services task force and the National Institutes of Health Office of medical applications of research. Ann Intern Med 159(2):123–129. https://doi.org/10.7326/0003-4819-159-2-201307160-00661
Crowther CA, Hiller JE, Moss JR et al (2005) Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 352(24):2477–2486. https://doi.org/10.1056/NEJMoa042973
Landon MB, Spong CY, Thom E et al (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 361(14):1339–1348. https://doi.org/10.1056/NEJMoa0902430
Mathiesen ER, Ringholm L, Damm P (2011) Stillbirth in diabetic pregnancies. Best Pract Res Clin Obstet Gynaecol 25(1):105–111. https://doi.org/10.1016/j.bpobgyn.2010.11.001
Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R (2014) Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia 57(2):285–294. https://doi.org/10.1007/s00125-013-3108-5
Hutcheon JA, Kuret V, Joseph KS, Sabr Y, Lim K (2013) Immortal time bias in the study of stillbirth risk factors: the example of gestational diabetes. Epidemiology 24(6):787–790. https://doi.org/10.1097/EDE.0b013e3182a6d9aa
Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB (2012) The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol 206(4):309 e301-307. https://doi.org/10.1016/j.ajog.2012.01.014
Girz BA, Divon MY, Merkatz IR (1992) Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes. J Perinatol 12(3):229–233
Reddy UM, Laughon SK, Sun L, Troendle J, Willinger M, Zhang J (2010) Prepregnancy risk factors for antepartum stillbirth in the United States. Obstet Gynecol 116(5):1119–1126. https://doi.org/10.1097/AOG.0b013e3181f903f8
Fretts R (2010) Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clin Obstet Gynecol 53(3):588–596. https://doi.org/10.1097/GRF.0b013e3181eb63fc
Aune D, Saugstad OD, Henriksen T, Tonstad S (2014) Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 311(15):1536–1546. https://doi.org/10.1001/jama.2014.2269
Yao R, Park BY, Foster SE, Caughey AB (2017) The association between gestational weight gain and risk of stillbirth: a population-based cohort study. Ann Epidemiol 27(10):638–644 e631. https://doi.org/10.1016/j.annepidem.2017.09.006
Stacey T, Tennant P, McCowan L et al (2019) Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK. BJOG 126(8):973–982. https://doi.org/10.1111/1471-0528.15659
Berger H, Gagnon R, Sermer M et al (2016) Diabetes in pregnancy. J Obstet Gynaecol Can 38(7):667–679 e661. https://doi.org/10.1016/j.jogc.2016.04.002
Diabetes Canada Clinical Practice Guidelines Expert Commitee, Feig DS, Berger H et al (2018) Diabetes and pregnancy. Can J Diabetes 42(Suppl 1):S255–S282. https://doi.org/10.1016/j.jcjd.2017.10.038
Kapur A, Mahmood T, Hod M (2018) FIGO's response to the global challenge of hyperglycemia in pregnancy - toward a global consensus. Gynecol Endocrinol 34(1):1–3. https://doi.org/10.1080/09513590.2017.1381682
Zhang M, Zhou Y, Zhong J, Wang K, Ding Y, Li L (2019) Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal. BMC Pregnancy Childbirth 19(1):200. https://doi.org/10.1186/s12884-019-2343-2
Coates D, Homer C, Wilson A et al (2020) Induction of labour indications and timing: a systematic analysis of clinical guidelines. Women Birth 33(3):219–230. https://doi.org/10.1016/j.wombi.2019.06.004
Patricia Lemieux JB, Jennifer Yamamoto, Lois Donovan. (PROSPERO 2020 CRD42020166939) The relationship between gestational diabetes and stillbirth: A systematic review and meta-analysis. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166939. Accessed 12 Jan 2021
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012. https://doi.org/10.1001/jama.283.15.2008
Bradburn MJ, Deeks JJ, Berlin JA, Russell Localio A (2007) Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events. Stat Med 26(1):53–77. https://doi.org/10.1002/sim.2528
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269, W264. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Bashir M, Aboulfotouh M, Dabbous Z et al (2020) Metformin-treated-GDM has lower risk of macrosomia compared to diet-treated GDM- a retrospective cohort study. J Matern Fetal Neonatal Med 33(14):2366–2371. https://doi.org/10.1080/14767058.2018.1550480
Alfadhli EM, Osman EN, Basri TH et al (2015) Gestational diabetes among Saudi women: prevalence, risk factors and pregnancy outcomes. Ann Saudi Med 35(3):222–230. https://doi.org/10.5144/0256-4947.2015.222
Wells GAS BOC, D, Peterson J, Welch V, Losos M, Tugwell P The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses (2020), Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp, Accessed 24 Jan 2020
Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors) (2020) Cochrane Handbook for Systematic Reviews of Interventions, version 6.1 (updated September 2020), Cochrane, Available from: www.training.cochrane.org/handbook
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557
Bhat M, Ramesha KN, Sarma SP, Menon S, Ganesh Kumar S (2012) Outcome of gestational diabetes mellitus from a tertiary referral center in South India: a case-control study. J Obstet Gynaecol India 62(6):644–649. https://doi.org/10.1007/s13224-012-0226-9
Bogdanet D, Egan AM, Reddin C et al (2017) ATLANTIC DIP: insulin therapy for women with IADPSG-diagnosed gestational diabetes mellitus. Does it work? J Clin Endocrinol Metab 102(3):849–857. https://doi.org/10.1210/jc.2016-2911
Ijas H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vaarasmaki M (2019) Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: a register-based study. PLoS One 14(8):e0221549. https://doi.org/10.1371/journal.pone.0221549
Aberg A, Rydhstroem H, Frid A (2001) Impaired glucose tolerance associated with adverse pregnancy outcome: a population-based study in southern Sweden. Am J Obstet Gynecol 184(2):77–83. https://doi.org/10.1067/mob.2001.108085
Aberg A, Rydhstrom H, Kallen B, Kallen K (1997) Impaired glucose tolerance during pregnancy is associated with increased fetal mortality in preceding sibs. Acta Obstet Gynecol Scand 76(3):212–217
Abolfazl M, Hamidreza T, Narges M, Maryam Y (2008) Gestational diabetes and its association with unpleasant outcomes of pregnancy. Pak J Med Sci 24(4):566–570
Aljohani N, Rempel BM, Ludwig S et al (2008) Impact of diabetes on maternal-fetal outcomes in Manitoba: relationship with ethnic and environmental factors. Clin Invest Med 31(6):E338–E345. https://doi.org/10.25011/cim.v31i6.4919
Al Teheawt M, Farida el BF (1995) Comparative study on: morbidity and mortality among neonates of gestational and frank diabetic mothers. J Egypt Public Health Assoc 70(5–6):679–697
Barakat MN, Youssef RM, Al-Lawati JA (2010) Pregnancy outcomes of diabetic women: charting Oman's progress towards the goals of the Saint Vincent declaration. Ann Saudi Med 30(4):265–270. https://doi.org/10.4103/0256-4947.65253
Bawah AT, Ngala RA, Alidu H, Seini MM, Wumbee JDK, Yeboah FA (2019) Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community. Pan Afr Med J 32:94. https://doi.org/10.11604/pamj.2019.32.94.17334
Berg M, Adlerberth A, Sultan B, Wennergren M, Wallin G (2007) Early random capillary glucose level screening and multidisciplinary antenatal teamwork to improve outcome in gestational diabetes mellitus. Acta Obstet Gynecol Scand 86(3):283–290. https://doi.org/10.1080/00016340601110747
Casey BM, Lucas MJ, McIntire DD, Leveno KJ (1997) Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol 90(6):869–873. https://doi.org/10.1016/s0029-7844(97)00542-5
Chirenje MZ (1992) The effects of established and gestational diabetes on pregnancy outcome at Harare maternity hospital. Cent Afr J Med 38(5):179–181
Chou CY, Lin CL, Yang CK, Yang WC, Lee FK, Tsai MS (2010) Pregnancy outcomes of Taiwanese women with gestational diabetes mellitus: a comparison of Carpenter-Coustan and National Diabetes Data Group criteria. J Women's Health (Larchmt) 19(5):935–939. https://doi.org/10.1089/jwh.2009.1620
Djelmis J, Blajic J, Bukovic D et al (1997) Glycosylated hemoglobin and fetal growth in normal, gestational and insulin dependent diabetes mellitus pregnancies. Coll Antropol 21(2):621–629
Donovan LE, Edwards AL, Savu A et al (2017) Population-level outcomes with a 2-step approach for gestational diabetes screening and diagnosis. Can J Diabetes 41(6):596–602. https://doi.org/10.1016/j.jcjd.2016.12.010
Dyck RF, Karunanayake C, Pahwa P, Stang M, Osgood ND (2020) Epidemiology of diabetes in pregnancy among first nations and non-first nations women in Saskatchewan, 19802013. Part 2: predictors and early complications; results from the DIP: ORRIIGENSS project. Can J Diabetes 44(7):605–614. https://doi.org/10.1016/j.jcjd.2019.11.001
El Mallah KO, Narchi H, Kulaylat NA, Shaban MS (1997) Gestational and pre-gestational diabetes: comparison of maternal and fetal characteristics and outcome. Int J Gynaecol Obstet 58(2):203–209. https://doi.org/10.1016/s0020-7292(97)00084-2
Ethridge JK Jr, Catalano PM, Waters TP (2014) Perinatal outcomes associated with the diagnosis of gestational diabetes made by the international association of the diabetes and pregnancy study groups criteria. Obstet Gynecol 124(3):571–578. https://doi.org/10.1097/AOG.0000000000000412
Feng R, Liu L, Zhang YY, Yuan ZS, Gao L, Zuo CT (2018) Unsatisfactory glucose management and adverse pregnancy outcomes of gestational diabetes mellitus in the real world of clinical practice: a retrospective study. Chin Med J 131(9):1079–1085. https://doi.org/10.4103/0366-6999.230718
Hilden K, Hanson U, Persson M, Magnuson A, Simmons D, Fadl H (2019) Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden. Diabet Med 36(2):151–157. https://doi.org/10.1111/dme.13843
Hossein-Nezhad A, Maghbooli Z, Vassigh AR, Larijani B (2007) Prevalence of gestational diabetes mellitus and pregnancy outcomes in Iranian women. Taiwan J Obstet Gynecol 46(3):236–241. https://doi.org/10.1016/S1028-4559(08)60026-1
Jiang S, Chipps D, Cheung WN, Mongelli M (2017) Comparison of adverse pregnancy outcomes based on the new IADPSG 2010 gestational diabetes criteria and maternal body mass index. Aust N Z J Obstet Gynaecol 57(5):533–539. https://doi.org/10.1111/ajo.12628
Johnstone FD, Nasrat AA, Prescott RJ (1990) The effect of established and gestational diabetes on pregnancy outcome. Br J Obstet Gynaecol 97(11):1009–1015. https://doi.org/10.1111/j.1471-0528.1990.tb02473.x
Jovanovic L, Liang Y, Weng W, Hamilton M, Chen L, Wintfeld N (2015) Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev 31(7):707–716. https://doi.org/10.1002/dmrr.2656
Kalra P, Kachhwaha CP, Singh HV (2013) Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. Indian J Endocrinol Metab 17(4):677–680. https://doi.org/10.4103/2230-8210.113760
Karmon A, Levy A, Holcberg G, Wiznitzer A, Mazor M, Sheiner E (2009) Decreased perinatal mortality among women with diet-controlled gestational diabetes mellitus. Int J Gynaecol Obstet 104(3):199–202. https://doi.org/10.1016/j.ijgo.2008.09.016
Keshavarz M, Cheung NW, Babaee GR, Moghadam HK, Ajami ME, Shariati M (2005) Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 69(3):279–286. https://doi.org/10.1016/j.diabres.2005.01.011
Khatun N, Latif SA, Uddin MM (2005) Infant outcomes of gestational diabetes mellitus. Mymensingh Med J 14(1):29–31
Koning SH, van Zanden JJ, Hoogenberg K et al (2018) New diagnostic criteria for gestational diabetes mellitus and their impact on the number of diagnoses and pregnancy outcomes. Diabetologia 61(4):800–809. https://doi.org/10.1007/s00125-017-4506-x
Lai FY, Johnson JA, Dover D, Kaul P (2016) Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005-11. J Diabetes 8(1):45–55. https://doi.org/10.1111/1753-0407.12255
Lamminpaa R, Vehvilainen-Julkunen K, Gissler M, Selander T, Heinonen S (2016) Pregnancy outcomes in women aged 35 years or older with gestational diabetes - a registry-based study in Finland. J Matern Fetal Neonatal Med 29(1):55–59. https://doi.org/10.3109/14767058.2014.986450
Li MF, Ma L, Yu TP et al (2020) Adverse maternal and neonatal outcomes in pregnant women with abnormal glucose metabolism. Diabetes Res Clin Pract 161:108085. https://doi.org/10.1016/j.diabres.2020.108085
Magee MS, Walden CE, Benedetti TJ, Knopp RH (1993) Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. JAMA 269(5):609–615. https://doi.org/10.1001/jama.1993.03500050087031
Mahalakshmi MM, Bhavadharini B, Maheswari K et al (2016) Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: a situational analysis study (WINGS-3). Indian J Endocrinol Metab 20(4):491–496. https://doi.org/10.4103/2230-8210.183469
Morikawa M, Sugiyama T, Sagawa N et al (2017) Perinatal mortality in Japanese women diagnosed with gestational diabetes mellitus and diabetes mellitus. J Obstet Gynaecol Res 43(11):1700–1707. https://doi.org/10.1111/jog.13431
Nayak PK, Mitra S, Sahoo JP, Daniel M, Mathew A, Padma A (2013) Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Diabetes Metab Syndr 7(4):206–209. https://doi.org/10.1016/j.dsx.2013.10.017
Nguyen CL, Lee AH, Minh Pham N et al (2020) Prevalence and pregnancy outcomes of gestational diabetes mellitus by different international diagnostic criteria: a prospective cohort study in Vietnam. J Matern Fetal Neonatal Med 33(21):3706–3712. https://doi.org/10.1080/14767058.2019.1583733
Odar E, Wandabwa J, Kiondo P (2004) Maternal and fetal outcome of gestational diabetes mellitus in Mulago hospital, Uganda. Afr Health Sci 4(1):9–14
Ovesen PG, Jensen DM, Damm P, Rasmussen S, Kesmodel US (2015) Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. A nation-wide study. J Matern Fetal Neonatal Med 28(14):1720–1724. https://doi.org/10.3109/14767058.2014.966677
Panigrahi A, Mallicka M, Panda J (2020) Gestational diabetes mellitus, its associated factors, and the pregnancy outcomes among pregnant women attending tertiary care hospitals of Bhubaneswar, India. Int J Diabetes Dev Ctries 40(3):371–378. https://doi.org/10.1007/s13410-020-00798-4
Pan L, Leng J, Liu G et al (2015) Pregnancy outcomes of Chinese women with gestational diabetes mellitus defined by the IADPSG's but not by the 1999 WHO's criteria. Clin Endocrinol 83(5):684–693. https://doi.org/10.1111/cen.12801
Peticca P, Keely EJ, Walker MC, Yang Q, Bottomley J (2009) Pregnancy outcomes in diabetes subtypes: how do they compare? A province-based study of Ontario, 2005-2006. J Obstet Gynaecol Can 31(6):487–496. https://doi.org/10.1016/S1701-2163(16)34210-4
Pintaudi B, Lucisano G, Pellegrini F et al (2015) The long-term effects of stillbirth on women with and without gestational diabetes: a population-based cohort study. Diabetologia 58(1):67–74. https://doi.org/10.1007/s00125-014-3403-9
Ramachandran A, Snehalatha C, Clementina M, Sasikala R, Vijay V (1998) Foetal outcome in gestational diabetes in south Indians. Diabetes Res Clin Pract 41(3):185–189. https://doi.org/10.1016/s0168-8227(98)00081-3
Riskin A, Itzchaki O, Bader D, Iofe A, Toropine A, Riskin-Mashiah S (2020) Perinatal outcomes in infants of mothers with diabetes in pregnancy. Isr Med Assoc J 22(9):569–575
Shand AW, Bell JC, McElduff A, Morris J, Roberts CL (2008) Outcomes of pregnancies in women with pre-gestational diabetes mellitus and gestational diabetes mellitus; a population-based study in New South Wales, Australia, 1998-2002. Diabet Med 25(6):708–715. https://doi.org/10.1111/j.1464-5491.2008.02431.x
Shen Y, Jia Y, Zhou J et al (2020) Association of gestational diabetes mellitus with adverse pregnancy outcomes: our experience and meta-analysis. Int J Diabetes Dev Ctries 40(3):357–370. https://doi.org/10.1007/s13410-020-00802-x
Shindo R, Aoki S, Kasai J, Saigusa Y, Nakanishi S, Miyagi E (2020) Impact of introducing the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria on pregnancy outcomes in Japan. Endocr J 67(1):15–20. https://doi.org/10.1507/endocrj.EJ19-0279
Soliman A, Salama H, Al Rifai H et al (2018) The effect of different forms of dysglycemia during pregnancy on maternal and fetal outcomes in treated women and comparison with large cohort studies. Acta Biomed 89(S5):11–21. https://doi.org/10.23750/abm.v89iS4.7356
Srichumchit S, Luewan S, Tongsong T (2015) Outcomes of pregnancy with gestational diabetes mellitus. Int J Gynaecol Obstet 131(3):251–254. https://doi.org/10.1016/j.ijgo.2015.05.033
Stone CA, McLachlan KA, Halliday JL, Wein P, Tippett C (2002) Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes. Med J Aust 177(9):486–491. https://doi.org/10.5694/j.1326-5377.2002.tb04916.x
Svare JA, Hansen BB, Molsted-Pedersen L (2001) Perinatal complications in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand 80(10):899–904. https://doi.org/10.1034/j.1600-0412.2001.801006.x
Tavera G, Dongarwar D, Salemi JL et al (2021) Diabetes in pregnancy and risk of near-miss, maternal mortality and foetal outcomes in the USA: a retrospective cross-sectional analysis. J Public Health (Oxf). https://doi.org/10.1093/pubmed/fdab117
Vivet-Lefebure A, Roman H, Robillard PY et al (2007) Obstetrical and neonatal outcomes of gestational diabetes mellitus at Reunion Island (France). Gynecol Obstet Fertil 35(6):530–535. https://doi.org/10.1016/j.gyobfe.2007.04.010
Wahabi HA, Esmaeil SA, Fayed A, Alzeidan RA (2013) Gestational diabetes mellitus: maternal and perinatal outcomes in King Khalid University Hospital, Saudi Arabia. J Egypt Public Health Assoc 88(2):104–108. https://doi.org/10.1097/01.EPX.0000430392.57811.20
Wahabi H, Fayed A, Esmaeil S, Mamdouh H, Kotb R (2017) Prevalence and complications of Pregestational and gestational diabetes in Saudi women: analysis from Riyadh mother and baby cohort study (RAHMA). Biomed Res Int 2017:6878263. https://doi.org/10.1155/2017/6878263
Xiong X, Saunders LD, Wang FL, Demianczuk NN (2001) Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet 75(3):221–228. https://doi.org/10.1016/s0020-7292(01)00496-9
Young S-C, Yiu M-S, So PL (2020) Effect of new diagnostic criteria on detection and pregnancy outcomes of gestational diabetes mellitus: a retrospective study. Hong Kong J Gynaecol Obstet Midwifery 20:16–21. https://doi.org/10.12809/hkjgom.20.1.02
Challis K, Melo A, Bugalho A, Jeppsson JO, Bergstrom S (2002) Gestational diabetes mellitus and fetal death in Mozambique: an incident case-referent study. Acta Obstet Gynecol Scand 81(6):560–563. https://doi.org/10.1034/j.1600-0412.2002.810615.x
Gwako GN, Obimbo MM, Gichangi PB, Kinuthia J, Gachuno OW, Were F (2021) Association between obstetric and medical risk factors and stillbirths in a low-income urban setting. Int J Gynaecol Obstet 154(2):331–336. https://doi.org/10.1002/ijgo.13528
Ibiebele I, Coory M, Smith GC et al (2016) Gestational age specific stillbirth risk among indigenous and non-indigenous women in Queensland, Australia: a population based study. BMC Pregnancy Childbirth 16(1):159. https://doi.org/10.1186/s12884-016-0943-7
Maleki Z, Ghaem H, Seif M, Foruhari S (2021) Incidence and maternal-fetal risk factors of stillbirth. A population-based historical cohort and a nested casecontrol study. Ann Ig 33(3):231–241. https://doi.org/10.7416/ai.2021.2430
Ohana O, Holcberg G, Sergienko R, Sheiner E (2011) Risk factors for intrauterine fetal death (1988-2009). J Matern Fetal Neonatal Med 24(9):1079–1083. https://doi.org/10.3109/14767058.2010.545918
Tabatabaee HR, Zahedi A, Etemad K et al (2020) Risk of stillbirth in women with gestational diabetes and high blood pressure. Iran J Public Health 49(4):773–781
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682. https://doi.org/10.2337/dc09-1848
Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144(7):768–773. https://doi.org/10.1016/0002-9378(82)90349-0
Lawn JE, Blencowe H, Waiswa P et al (2016) Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 387(10018):587–603. https://doi.org/10.1016/S0140-6736(15)00837-5
Kiguli J, Munabi IG, Ssegujja E et al (2016) Stillbirths in sub-Saharan Africa: unspoken grief. Lancet 387(10018):e16–e18. https://doi.org/10.1016/S0140-6736(15)01171-X
Fretts RC, Schmittdiel J, McLean FH, Usher RH, Goldman MB (1995) Increased maternal age and the risk of fetal death. N Engl J Med 333(15):953–957. https://doi.org/10.1056/NEJM199510123331501
Davidson SJ, de Jersey SJ, Britten FL, Wolski P, Sekar R, Callaway LK (2021) Fetal ultrasound scans to guide management of gestational diabetes: improved neonatal outcomes in routine clinical practice. Diabetes Res Clin Pract 173:108696. https://doi.org/10.1016/j.diabres.2021.108696
Sukumaran S, Madhuvrata P, Bustani R, Song S, Farrell TA (2014) Screening, diagnosis and management of gestational diabetes mellitus: a national survey. Obstet Med 7(3):111–115. https://doi.org/10.1177/1753495X14536891
Po G, Salerno C, Monari F, Grandi G, Facchinetti F, Stillbirth Emilia-Romagna Audit Group (2021) Potentially preventable antepartum stillbirths in a high-resource setting: a prospective audit-based study. Eur J Obstet Gynecol Reprod Biol 258:228–234. https://doi.org/10.1016/j.ejogrb.2021.01.006
Rao U, de Vries B, Ross GP, Gordon A (2019) Fetal biometry for guiding the medical management of women with gestational diabetes mellitus for improving maternal and perinatal health. Cochrane Database Syst Rev 9:CD012544. https://doi.org/10.1002/14651858.CD012544.pub2
Jin D, Rich-Edwards JW, Chen C et al (2020) Gestational diabetes mellitus: predictive value of fetal growth measurements by ultrasonography at 22-24 weeks: a retrospective cohort study of medical records. Nutrients 12(12):3645. https://doi.org/10.3390/nu12123645
Mayo K, Melamed N, Vandenberghe H, Berger H (2015) The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol 212(2):224 e221-229. https://doi.org/10.1016/j.ajog.2014.08.027
Leary J, Pettitt DJ, Jovanovic L (2010) Gestational diabetes guidelines in a HAPO world. Best Pract Res Clin Endocrinol Metab 24(4):673–685. https://doi.org/10.1016/j.beem.2010.05.009
Sandu C, Bica C, Salmen T et al (2021) Gestational diabetes - modern management and therapeutic approach (review). Exp Ther Med 21(1):81. https://doi.org/10.3892/etm.2020.9512
Quaresima P, Visconti F, Chiefari E et al (2020) Appropriate timing of gestational diabetes mellitus diagnosis in medium- and low-risk women: effectiveness of the Italian NHS recommendations in preventing fetal macrosomia. J Diabetes Res 2020:5393952. https://doi.org/10.1155/2020/5393952
Acknowledgements
The authors would like to thank H. L. Robertson (University of Calgary, Calgary, Canada) for her expert advice in developing our search strategy.
Authors’ relationships and activities
CP reports grants from Manitoba Medical Services Foundation/Children’s Hospital Research Institute of Manitoba New Investigator Grant, non-financial support from the Society of Obstetricians & Gynaecologists of Canada, and a Winnipeg Foundation Martha Donovan Leadership Award, outside the submitted work. All other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
PL, JLB, LED and JMY conceived the idea for this systematic review and meta-analysis. PL and JLB conducted the literature search along with the initial title/abstract review, the full-text review and study selection. JMY contributed her expertise in systematic review methodology to the design and conduct of this systematic review. PL and NM conducted the data extraction and JMY did the statistical analysis. CP contributed to the interpretation of data and analyses. PL wrote the first draft of the manuscript with input from JMY. All authors contributed to critical review and approval of the final manuscript. JMY is the guarantor of this work.
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM
(PDF 4.47 kb)
Rights and permissions
About this article
Cite this article
Lemieux, P., Benham, J.L., Donovan, L.E. et al. The association between gestational diabetes and stillbirth: a systematic review and meta-analysis. Diabetologia 65, 37–54 (2022). https://doi.org/10.1007/s00125-021-05579-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00125-021-05579-0