Real-world evaluation of adverse pregnancy outcomes in women with gestational diabetes mellitus in the German health care system

Abstract Aims This study aims to estimate the incidence of adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) in Germany. Methods Pregnant women were identified from a health claims database for the year of 2016. Three groups were defined: general population without GDM, women with GDM without treatment and women with GDM and insulin treatment. Operationalisation of outcomes was aligned with the hyperglycaemia and adverse pregnancy outcomes (HAPO) study. Results The cohort consisted of 58,297 mother-child pairs. Of those, 7245 had a GDM diagnosis and 1407 had a GDM diagnosis with a prescription of insulin. Adverse pregnancy outcomes were higher in both GDM groups compared to the control group. Birthweight (OR 2.08 [95% CI 1.50–2.90]), primary caesarean section (OR 1.70 [95% CI 1.48–1.95]), intensive neonatal care (OR 1.25 [95% CI 1.04–1.50]), preeclampsia (OR 1.51 [95% CI 1.23–1.85]), and clinical neonatal hypoglycaemia (OR 5.32 [95% CI 4.27–6.62]) were higher in the GDM + insulin group in comparison to a control group after adjustment for potential confounders. Conclusion Most of the adverse pregnancy outcomes were moderately higher in both identified GDM groups in comparison to women without GDM. Women receiving insulin treatment are at an increased risk of most of the defined adverse pregnancy outcomes.