Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Fetal ultrasound scans to guide management of gestational diabetes: improved neonatal outcomes in routine clinical practice (#9)

Sarah J Davidson 1 2 3 , Susan J de Jersey 3 4 , Fiona L Britten 1 5 , Penny Wolski 1 , Renuka Sekar 1 , Leonie K Callaway 1 5
  1. Women's & Newborn Services, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
  2. Duke University School of Medicine, Durham, NC, USA
  3. Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
  4. Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
  5. Faculty of Medicine, University of Queensland, Herston, QLD, Australia

Objective: At a given level of glycemic control, fetal growth is variable in gestational diabetes mellitus (GDM). Some guidelines recommend altering glycemic targets in GDM based on ultrasound measurements of fetal growth, but the impact on outcomes in clinical practice is unknown. The aim of this study was to compare the effects of ultrasound-guided and non-ultrasound-guided management on neonatal outcomes.

Methods: This was a retrospective, observational study of women with GDM and their infants. The study sample was randomly selected from all eligible women who delivered at the study hospital from August 2015 to August 2019. Outcomes were compared between those who had GDM management tailored according to fetal growth and those who did not.

Results: In the sample of 221 women, 134 had documentation of ultrasound-guided management while 87 did not. There was no significant difference in size-for-gestational age between groups. Fewer neonates in the ultrasound-guided management group were admitted to the Special Care or Intensive Care Nursery (29.1% vs. 48.3%, P = 0.004), had a prolonged hospital stay (3.7% vs. 13.8%, P = 0.006), or had hypoglycemia after birth (42.5% vs. 56.3%, P = 0.045). The reduction in admission rates and prolonged hospital stays remained significant after controlling for confounding variables.

Conclusions: Ultrasound-guided management was independently associated with reductions in Special Care Nursery and Intensive Care Nursery admissions and neonatal length of stay despite no significant differences in birthweight.