The relationship between stillbirth and gestational diabetes versus no diabetes

Abstract

Overview: Gestational Diabetes Mellitus (GDM) is hyperglycaemia diagnosed for the first time during pregnancy (Plows et al., 2018). Unfortunately, the diagnosis brings certain adverse outcomes for both the mother and the foetus, one of which is stillbirth. It is estimated that GDM affects 5.6% of all pregnancies in Malta (Gatt, 2021). Therefore, by determining whether there is an increased likelihood of stillbirth, recommendations to improve local practice can be put forward. Research question: In pregnant women, does gestational diabetes lead to a higher likelihood of having a stillbirth when compared to non-diabetic pregnancies? PICO elements: Population (P): Pregnant females, Intervention (I): GDM, Comparison (C): Non-diabetics, Outcome (O): Stillbirth Method: A search of the relevant literature was carried out using various electronic databases. Only studies published from 2017 onwards which were peer-reviewed, written in English, and either a Systematic Review (SR), Meta-Analysis (MA), Randomised Controlled Trial, Cohort Study, or Cross-Sectional study were considered. Studies that investigated stillbirth in regard to other forms of diabetes, that assessed GDM with livebirths or miscarriages and that were not fully available were excluded from this search. The search resulted in three relevant articles, two SRs and one cross-sectional study. The CASP tool was used to appraise the SRs and the AXIS tool was used to appraise the cross-sectional study. Results: From the appraisals and discussion, the results showed that GDM increases the likelihood of stillbirth, especially late stillbirth. Implications and Recommendations: Increased awareness of the risk of stillbirth in mothers with GDM implies a need for special care especially in the late pregnancy period. Recommendations include that further research be conducted locally to accurately quantify the problem and possibly provide individualised monitoring. Greater investment in staff training and patient education is also recommended to achieve optimal glucose control and allow mothers an untroubled pregnancy.