THE ASSOCIATION OF HISTORY OF PREVIOUS SPONTANEOUS ABORTION OR STILLBIRTH WITH SUBSEQUENT RISK OF GESTATIONAL DIABETES MELLITUS
Abstract
Introduction: Gestational diabetes mellitus (GDM) is a disorder of glucose metabolism, with varying degrees of clinical severity, that first appears during pregnancy. The aim of this study is to examine the association of a history of previous spontaneous abortions and stillbirths with the occurrence of GDM in the current pregnancy. Material and methods: The study included all pregnant women who underwent an OGTT (Oral Glucose Tolerance Test) for the diagnosis of GDM, in the period of 3 years, at the University Clinic for Endocrinology, Diabetes and Metabolic Disorders – Skopje. Patients were divided into two groups: Study group (with a positive OGTT) and Control group (with negative OGTT). Anamnestic and laboratory parameters were provided by medical documentation. Results: The analysis indicated that pregnant women with positive OGTT had a significantly higher number of previous miscarriages compared to pregnant women with a negative OGTT (Pearson Chi-square=8.6521, df=3, p=0.0343). According to the analysis, pregnant women with a positive OGTT had significantly more stillbirths compared to pregnant women with a negative OGTT status (Pearson Chi-square=9.5779, df=2, p=0.0083). Conclusion: History of previous miscarriages significantly increases the risk of gestational diabetes mellitus. A history of one miscarriage significantly increases the likelihood of gestational diabetes mellitus by 1.599 times. A history of two miscarriages significantly increases the likelihood of gestational diabetes mellitus by 2.339 times. Pregnant women with a positive history of one previous stillbirth are 4.365 times more likely to have a positive OGTT status compared to pregnant women who have not had any stillbirths.
Keywords: gestational diabetes mellitus, spontaneous abortion, stillbirth.
References
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12668-1_12
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cohort study. Endocr Connect. 2018;7(5):681-687. doi:10.1530/EC-18-0093
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26. Tennant PW, Glinianaia SV, Bilous RW, et al. Pre-existing diabetes, maternal glycated haemoglobin,
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30. Vaajala M, Liukkonen R, Ponkilainen V et al. Previous induced abortion or miscariage is associated
with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland. Acta
Diabetologica 2023;60:845-849. https://doi.org/10.1007/s00592-023-02047-6
31. Zhao Y, Zhao Y, Fan K, Jin L. Association of history of spontaneous or induced abortion with
subsequent risk of gestational diabetes. JAMA Netw Open 2022; 5(3):e220944
32. Wang H, Guo X, Song Q, et al. Association between the history of abortion and gestational diabetes
mellitus: a meta-analysis. Endocrine 2022; 80(1):29-39. https:// doi. org/ 10. 1007/ s12020- 022- 03246-
x
33. Egerup P, Mikkelsen AP, Kolte AM, et al. Pregnancy loss is associated with type 2 diabetes: a
nationwide case–control study. Diabetologia 2020; 63(8):1521–1529. https://doi.org/10.1007/s00125-
020-05154-z.
34. Dunne J, Foo D, Dachew BA, et al. Diabetic and hypertensive disorders following early pregnancy
loss: a systematic review and meta-analysis. eClinicalMedicine 2024;71: 102560.
https://doi.org/10.1016/j.eclinm.2024.102560
35. Lemieux P, Benham JL, Donovan LE et al. The association between gestational gestational diabetes
and stillbirth: a systematic review and metaanalysis. Diabetologia 2022; 65:37-54.
https://doi.org/10.1007/s00125-021-05579-0.
Diabetes Care 2001;24:S77-S79
2. Guariguata L, Linnenkamp U, Beagley J, et al. Global estimates of the prevalence of hyperglycaemia
in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176-185. doi:10.1016/j.diabres.2013.11.003
3. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes
Care. 2007;30(2)(suppl):S141-S146. doi:10.2337/dc07-s206
4. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global
perspective. Curr Diab Rep. 2016;16(1):7. doi:10.1007/s11892-015-0699-x
5. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes:
a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-1779. doi:10.1016/S0140-
6736(09)60731-5
6. CarpenterMW. Gestational diabetes, pregnancy hypertension, and late vascular disease. Diabetes Care.
2007; 30(2)(suppl):S246-S250. doi:10.2337/dc07-s224
7. Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery: short-term
management and long-term risks. Diabetes Care. 2007;30(2)(suppl):S225-S235. doi:10.2337/dc07-
s221
8. Sullivan SD, Umans JG, Ratner R. Gestational diabetes: implications for cardiovascular health. Curr
Diab Rep. 2012;12(1):43-52. doi:10.1007/s11892-011-0238-3
9. West NA, Crume TL, Maligie MA, Dabelea D. Cardiovascular risk factors in children exposed to
maternal diabetes in utero. Diabetologia. 2011;54(3):504-507. doi:10.1007/s00125-010-2008-1
10. Gestational diabetes mellitus. American diabetes association. Diabetes Care 27 Suppl 1: S88-S90.
11. Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368(9535):601-611. doi:10.1016/S0140-
6736(06)69204-0
12. Gupta S, Agarwal A, Banerjee J, Alvarez JG. The role of oxidative stress in spontaneous abortion and
recurrent pregnancy loss: a systematic review. Obstet Gynecol Surv. 2007;62(5):335-347.
doi:10.1097/01.ogx.0000261644.89300.df
13. 1Sedgh G, Singh S, Shah IH, et al. Induced abortion: incidence and trends worldwide from 1995 to
2008. Lancet. 2012;379(9816):625-632. doi:10.1016/S0140-6736(11)61786-8
14. Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical,
psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-1667.
doi:10.1016/S0140-6736(21)00682-6
15. Horn J, Tanz LJ, Stuart JJ, et al. Early or late pregnancy loss and development of clinical cardiovascular
disease risk factors: a prospective cohort study. BJOG. 2019;126(1):33-42. doi:10.1111/1471-
0528.15452
16. Asgharvahedi F, Gholizadeh L, Siabani S. The risk of cardiovascular disease in women with a history
of miscarriage and/or stillbirth. Health CareWomen Int. 2019;40(10):1117-1131.
doi:10.1080/07399332.2019.1566332
17. Wagner MM, Bhattacharya S, Visser J, et al. Association between miscarriage and cardiovascular
disease in a Scottish cohort. Heart. 2015;101(24):1954-1960. doi:10.1136/heartjnl-2015-307563.
Liu Y, Lu J, Xu M, et al. Association between history of abortion and nonalcoholic fatty liver disease
in middleaged and elderly Chinese women. Ann Epidemiol. 2013;23(3):119-123.
doi:10.1016/j.annepidem.2012.12.002
19. Peters SAE, Yang L, Guo Y, et al; China Kadoorie Biobank Collaboration Group. Pregnancy,
pregnancy loss and the risk of diabetes in Chinese women: findings from the China Kadoorie Biobank.
Eur J Epidemiol. 2020;35(3):295-303. doi:10.1007/s10654-019-00582-7
20. Xu B, Zhang J, Xu Y, et al. Association between history of abortion and metabolic syndrome in middleaged and elderly Chinese women. Front Med. 2013;7(1):132-137. doi:10.1007/s11684-013-0250-x
21. Ahmed SK, Mahmood N, Malalla ZH, et al. C-reactive protein gene variants associated with recurrent
pregnancy loss independent of CRP serum levels: a case-control study. Gene. 2015;569(1):136-140.
doi:10.1016/j.gene.2015.05.052
22. Khambule L, George JA. The role of inflammation in the development of GDM and the use of markers
of inflammation in GDM screening. Adv Exp Med Biol. 2019;1134:217-242. doi:10.1007/978-3-030-
12668-1_12
23. Rueangdetnarong H, Sekararithi R, Jaiwongkam T, et al. Comparisons of the oxidative stress
biomarkers levels in gestational diabetes mellitus (GDM) and non-GDM among Thai population:
cohort study. Endocr Connect. 2018;7(5):681-687. doi:10.1530/EC-18-0093
24. Lappas M, Hiden U, Desoye G, et al. The role of oxidative stress in the pathophysiology of gestational
diabetes mellitus. Antioxid Redox Signal. 2011;15(12):3061-3100. doi:10.1089/ars.2010.3765
25. Mathiesen ER, Ringholm L, Damm P. Stillbirth in diabetic pregnancies. Best Pract Res Clin Obstet
Gynaecol 2011; 25(1):105–111. https://doi.org/10.1016/j.bpobgyn.2010.11.001
26. Tennant PW, Glinianaia SV, Bilous RW, et al. Pre-existing diabetes, maternal glycated haemoglobin,
and the risks of fetal and infant death: a population-based study. Diabetologia 2014; 57(2):285–294.
https://doi.org/10.1007/s00125-013-3108-5
27. Hutcheon JA, Kuret V, Joseph KS, et al. Immortal time bias in the study of stillbirth risk factors: the
example of gestational diabetes. Epidemiology 2013;24(6):787–790.
https://doi.org/10.1097/EDE.0b013e3182a6d9aa
28. Rosenstein MG, Cheng YW, Snowden JM, et al. The risk of stillbirth and infant death stratified by
gestational age in women with gestational diabetes. Am J Obstet Gynecol 22012; 206(4):309 e301-307.
https://doi.org/10. 1016/j.ajog.2012.01.014
29. Metzger BE, Gabbe SG, Persson B, et al; International Association of Diabetes and Pregnancy Study
Groups Consensus Panel. International association of diabetes and pregnancy study groups
recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care.
2010;33(3):676-682. doi:10.2337/dc09-1848
30. Vaajala M, Liukkonen R, Ponkilainen V et al. Previous induced abortion or miscariage is associated
with increased odds for gestational diabetes: a nationwide register-based cohort study in Finland. Acta
Diabetologica 2023;60:845-849. https://doi.org/10.1007/s00592-023-02047-6
31. Zhao Y, Zhao Y, Fan K, Jin L. Association of history of spontaneous or induced abortion with
subsequent risk of gestational diabetes. JAMA Netw Open 2022; 5(3):e220944
32. Wang H, Guo X, Song Q, et al. Association between the history of abortion and gestational diabetes
mellitus: a meta-analysis. Endocrine 2022; 80(1):29-39. https:// doi. org/ 10. 1007/ s12020- 022- 03246-
x
33. Egerup P, Mikkelsen AP, Kolte AM, et al. Pregnancy loss is associated with type 2 diabetes: a
nationwide case–control study. Diabetologia 2020; 63(8):1521–1529. https://doi.org/10.1007/s00125-
020-05154-z.
34. Dunne J, Foo D, Dachew BA, et al. Diabetic and hypertensive disorders following early pregnancy
loss: a systematic review and meta-analysis. eClinicalMedicine 2024;71: 102560.
https://doi.org/10.1016/j.eclinm.2024.102560
35. Lemieux P, Benham JL, Donovan LE et al. The association between gestational gestational diabetes
and stillbirth: a systematic review and metaanalysis. Diabetologia 2022; 65:37-54.
https://doi.org/10.1007/s00125-021-05579-0.
Published
2024-12-29
How to Cite
KOCEVSKA, Ana; SKEPAROVSKA, Kristina; MUCHA, Argjent.
THE ASSOCIATION OF HISTORY OF PREVIOUS SPONTANEOUS ABORTION OR STILLBIRTH WITH SUBSEQUENT RISK OF GESTATIONAL DIABETES MELLITUS.
Journal of Morphological Sciences, [S.l.], v. 7, n. 3, p. 7-15, dec. 2024.
ISSN 2545-4706.
Available at: <http://jms.mk/jms/article/view/vol7no3-2>. Date accessed: 04 feb. 2025.
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