COMPARATIVE ANALYSIS OF THE IMPACT OF VARIOUS RISK FACTORS ON THE COURSE AND OUTCOMES OF PREGNANCY IN GESTATIONAL DIABETES MELLITUS

Abstract

Introduction. Gestational diabetes mellitus (GDM) is one of the most common complicated forms of diabetes that develops during pregnancy. The increasing prevalence of gestational diabetes, the high likelihood of adverse pregnancy outcomes for both the mother and fetus, as well as a range of long-term consequences of GDM, represent a serious medical and social problem, emphasizing the need for its prevention through risk factor correction, timely diagnosis, and effective treatment.
Objective of the study. To assess the structure of risk factors for GDM development, and to identify the relationship between GDM, the course, and outcomes of pregnancy.
Material and methods. Retrospective analysis of 684 medical records of patients with confirmed GDM from 2023 to 2025.
Results. The most significant risk factors for the mother and fetus were age and the timing of delivery. Women with insulin-treated GDM were older (median age 35 years) compared to the group with non-insulin-treated GDM (33 years) and the control group (32 years), p<0.001. They gave birth slightly earlier in the insulin-treated GDM group (median ~38 weeks). The parity and number of births were higher in the insulin-treated GDM group (4 deliveries), p=0.037. The insulin-treated GDM group required more frequent prevention of respiratory distress syndrome (35.1% of cases), p<0.001. Chronic hypertension was more common among women with insulin-treated GDM (19.2%), p=0.001. Women with insulin-treated GDM had a higher rate of obesity, p<0.001.
Among women with insulin-treated GDM and a uterine scar, the likelihood of a cesarean section was significantly higher (86%) compared to those without a scar (37%), OR=10.48, p<0.0001, which explains the high percentage of cesarean sections in the GDM group. The difference in newborn weight between the insulin and non-insulin GDM groups was not significant (median 3.6-3.7 kg), p=0.863. Women with insulin-treated GDM had a higher incidence of family history of diabetes (26.5%), p<0.001. The frequency of congenital anomalies was higher in the non-insulin-treated GDM group (20%), p<0.001.
Discussion of results. The article investigates the peculiarities of managing pregnancies in women with gestational diabetes mellitus (GDM). Women with gestational diabetes mellitus on insulin therapy over the age of 35±4.0 years are more likely to give birth prematurely at 38±1.75 weeks compared with the GSD group on diet therapy and the control group. Pregnant women with GDM on insulin therapy had a high weight of 89±15 kg (p<0.001). In the GDM group on insulin therapy, there is a high fasting glucose level of 5.63 [5.35; 5.90] mmol/l and 1 hour after eating 7.89 [7.45; 8.21] mmol/L, as well as the incidence of complications such as hypertension of 10.6% and obesity (grade 1 – 35.8%; grade 2 – 21.2%; Grade 3 – 11.3%, morbid – 1.3%), as well as a high risk of surgical delivery of 51%. Despite the increased frequency of cesarean sections, the condition of newborns on the Apgar scale does not differ from other groups. The study highlights the importance of careful disease control and pregnancy management in women with GDM who are on insulin therapy.

Conclusions. Thus, the results of the study confirm that insulin-treated GDM is a more complicated form of the disease requiring specific medical attention and monitoring. Women with this diagnosis have a higher risk of complications, both for themselves and their children, which justifies the need for increased attention during the management of such pregnancies.