Does previous pregnancy loss increase the risk for gestational diabetes?

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In Australia, gestational diabetes (GDM) affects around 10% of pregnancies with up to 30% of GDM pregnancies in a high-risk population. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of metabolic abnormalities in mother and her offspring. Several factors such as patient’s age and family history and raised body mass index (BMI) are associated with future higher risk for GDM. Women who experienced repeated miscarriages were reported to have a higher prevalence of insulin resistance, which increases their risk for gestational diabetes. ;Although up to 20 % of pregnancies end up in an unintended termination of pregnancy there is a paucity of data examining impact of women reproductive history on their future risk of GDM. A recent metanalysis of 10 studies has revealed a 1.62-fold risk of gestational diabetes (95% CI: 1.32–1.98) compared to those never experiencing a miscarriage. In this metanalysis the majority of collected data were ascertained from patients’ questionnaires without effect measure being adjusted for GDM predisposing risk factors. We are planning to conduct a case control study which will compare the previous exposures to miscarriage/termination of pregnancies in women with and without diagnosis of GDM. We will be aiming to analyse data on 500 GDM women and these data will be matched with data on 500 women of similar age and BMI and ethnicity however without GDM. We have already collected data on 150 women with GDM with the miscarriage prevalence of 33%. The proposed study design will have power of 0.80 and of 0.05 to detect a difference of 70% in GDM incidence in women with and without history of pregnancy loss. Considering the large number of miscarriages, evaluating the link between previous pregnancy loss and hyperglycaemia may allow for an additional monitoring and earlier intervention in women at high risk for GDM.

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