The Impact of Gestational Diabetes Mellitus on the Course and Outcomes of Pregnancy in Patients with a Uterine Scar

Introduction . The significance of gestational diabetes mellitus (GDM). The presence of a uterine scar worsens the perinatal prognosis.

Objective . To study the characteristics of the maternal history, pregnancy course, delivery, postpartum period, and morphological determinants of uterine scar defects in patients with gestational diabetes mellitus.

Materials and Methods . A retrospective cohort comparative study of the course and outcomes of pregnancy was conducted in 101 patients with a uterine scar following cesarean section (CS). Of these, 60 (the study group) were diagnosed with gestational diabetes mellitus. The comparison group consisted of 41 patients without GDM. Medical history, ultrasound data, and shear wave echo elastography were reviewed. Scar tissue was sent for histological examination. Results . The parity of pregnancy in patients of the main group is significantly higher; the anamnesis includes significantly more often induced abortions and obesity. The main complication of the current pregnancy is the threat of termination (OR 2.39 at 95 % CI [1.013–5.623]). Elastographic study revealed a significant positive correlation be_r_ tween the stiffness index and the presence of GDM ( = 0.82), the OR of uterine scar insufficiency in patients with gestational diabetes mellitus significantly increases and is 1.92 at 95 % CI [1.276–2.896]. When analyzing the clinical and morphological variants of scar insufficiency according to histological examination data, the “vascular” variant was confirmed significantly more often.

Conclusion . The main causes of uterine scar insufficiency in patients with gestational diabetes, increased tissue stiffness in diabetes, fetal macrosomia, and vascular wall changes are associated.

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