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RCOG World Congress 2025

June 23 - 25, 2025 | ExCeL London, UK

EP.1592

Gestational Diabetes Mellitus and Stillbirth: A Systematic Review and Meta-analysis

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Poster Presenter

Livia Samara

Authors

Livia Samara, Victoria Bradley, Miriam Toolam, Amelia Atkinson, Katie Barnard, Deborah Caldwell, Abigail Fraser, Shakila Thangaratinam, Gemma Clayton, Abi Merriel

Affiliations

University Hospitals Bristol and Weston NHS Foundation Trust, Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences,  University of Liverpool, Population Health Sciences, University of Bristol

Part of Topic

Maternal medicine

Gestational Diabetes Mellitus and Stillbirth: A Systematic Review and Meta-Analysis

Livia Samara1, Victoria Bradley2, Miriam Toolan3, Amelia Atkinson3, Katie Barnard3, Deborah Caldwell3, Abigail Fraser3, Shakila Thangaratinam2, Gemma Clayton3, Abi Merriel2

1University Hospitals Bristol and Weston NHS Foundation Trust, 2Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences,  University of Liverpool, 3Population Health Sciences, University of Bristol

•Gestational Diabetes Mellitus (GDM) affects 1 in 6 pregnancies worldwide[1]

•Stillbirth affects 2.6 million pregnancies each year and 98% of these occur in low and middle income countries[2]

•Studies conducted to assess the relationship between GDM and stillbirth have yielded inconsistent results[3]

•Screening methods for GDM vary widely worldwide. Universal screening involves offering testing to all women. Risk based, or selective screening involves only offering testing to those deemed at high risk of GDM[4]

FIGO and the (WHO) now recommend universal screening. However, a Cochrane review comparing method of screening found that there was insufficient evidence to evaluate the most appropriate method for GDM[

Primary aim: To estimate the association between GDM and stillbirth

Secondary aims: To identify the association between country income level and universal vs. risk based screening for GDM

•110 studies were included, see table 1

•Pooling adjusted cohort studies found that worldwide there was no clear evidence that GDM increases the risk of stillbirth (aOR 0.88 [95% CI: 0.69 – 1.12]), however in high income countries GDM was associated with a 26% reduction in stillbirth (aOR 0.75; [95% CI 0.65-0.84]) (Figure 2).

•When stratified by type of screening, there was no clear difference between universal screening (aOR 0.94 [95% CI: 0.61 – 1.45]) and risk based (aOR 0.85 [95% CI: 0.74 – 0.97]) (Figure 3).

•Our study supports the findings of a previous systematic that the relationship between stillbirth and GDM remains unclear[3] but our subgroup analysis has provided new insights.

•Reduction in stillbirths in high income countries is likely due to closer antenatal monitoring and earlier delivery.

•Risk based screening may be favourable. Subgroup analysis by country income level found that there was a reduction in high income countries for both methods, suggesting that country income level may be driving this observation and more research is required to examine this further

•Strengths of this review are the rigorous methodology and analysis of adjusted, high quality studies. Limitations are inclusion of only observational data and high levels of heterogeneity due to the nature of the topic

Women diagnosed with GDM in high income countries are at reduced risk of stillbirth compared to those without GDM, likely due to increased monitoring antenatal care and delivery at earlier gestation. Implementing high quality screening and GDM management programmes in low and middle income settings is likely to reduce preventable stillbirths worldwide.