Gestational diabetes mellitus is associated with adverse outcomes in singleton pregnancies conceived via assisted reproductive technology: a Nationwide Inpatient Sample analysis, 2008-2020.

Objective

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet its effects in singleton pregnancies conceived via assisted reproductive technology (ART) remain unclear. This study evaluated the association between GDM and maternal and fetal outcomes in this population.

Methods

This retrospective study used the U.S. Nationwide Inpatient Sample 2008-2020 to identify singleton pregnancies conceived via ART. Propensity-score matching was performed to balance baseline characteristics between women with and without GDM. Logistic regression assessed associations between GDM and adverse maternal and fetal outcomes.

Results

After matching, 9,625 women were included (1,925 with GDM and 7,700 without GDM). GDM was associated with higher odds of preeclampsia (odds ratio [OR] = 1.24, 95% confidence interval [CI]: 1.03-1.50), placenta previa (OR = 1.34, 95% CI: 1.08-1.66), cesarean delivery (OR = 1.30, 95% CI: 1.18-1.44), induction of labor (OR = 1.14, 95% CI: 1.02-1.28), extended hospital stay (OR = 1.48, 95% CI: 1.24-1.76), preterm birth (OR = 1.30, 95% CI: 1.10-1.53), and large for gestational age/fetal macrosomia (OR = 1.54, 95% CI: 1.26-1.90). Stratified analyses showed generally similar associations across subgroups, while formal interaction analyses identified significant interactions for selected outcomes.

Conclusion

GDM was significantly associated with adverse maternal and fetal outcomes in singleton pregnancies conceived via ART. These findings highlight the importance of vigilant clinical monitoring for complications such as preeclampsia, excessive fetal growth, preterm birth, and delivery-related complications in this high-risk population.