The relationship between first-trimester progesterone treatment and gestational diabetes.

BACKGROUND

Studies have shown that pregnancies conceived by assisted reproductive technology (ART) are associated with higher-than-normal rates of gestational diabetes mellitus (GDM). It remains unclear whether this association is attributable to techniques inherent to ART, particularly progesterone administration in the luteal phase, or other factors.

OBJECTIVE

To compare GDM rates between singleton pregnancies conceived spontaneously or by ART.

MATERIALS AND

METHODS

A retrospective cohort study was conducted over an 8-year period in a tertiary medical center. Participants included women with singleton pregnancies who gave birth after 24 completed weeks' gestation. Exclusion criteria were pregestational diabetes, multiple gestations, and second- or third-trimester progesterone exposure. GDM was diagnosed according to American Diabetes Association (ADA) guidelines. The rate of GDM was compared between women who conceived by ART, with first-trimester injection of progesterone, or spontaneously. A sub-analysis was conducted within the ART group by route of progesterone administration (vaginal, intramuscular, or both). Univariate analysis was followed by multivariable regression analysis with adjustment for potential confounders.

RESULTS

A total of 19,849 pregnancies were included: 1,276 (6.43 %) conceived by ART, and 18,573 conceived spontaneously. The rate of GDM was significantly higher in the ART group (12.7 % vs. 7.2 %, P < 0.001), but significance was lost after adjustment for maternal age, body mass index, and nulliparity. The route of progesterone administration did not significantly affect GDM rates.

CONCLUSION

Higher rates of GDM were observed in individuals who conceived via ART. Despite the exposure of the ART group to first-trimester progesterone, the association with GDM appeared to be influenced more by pre-existing characteristics of the patients, namely maternal age, body mass index, and parity. These data will help in risk stratification for GDM, and patient reassurance, in women undergoing ART.