Association between prior gestational diabetes mellitus and adverse pregnancy outcomes

Objective: This study aims to examine the independent association between a history of gestational diabetes mellitus (GDM) and adverse maternal-fetal outcomes in subsequent pregnancies, with the objective of informing evidence-based clinical management strategies for this high-risk population. Methods: This retrospective study included women who delivered at Shenzhen Longhua District People's Hospital between 2015 and 2025. Participants were categorized into a PGDM group (n=332) and a non-PGDM group (n=994) based on prior history of GDM. Propensity score matching was employed to control for confounding factors, and logistic regression analysis was used to assess the association between PGDM and adverse pregnancy outcomes. Results: Pregnant women with prior GDM had significantly higher risks of cesarean delivery (32.8% vs. 26.9%), GDM recurrence (50.0% vs. 11.8%), and gestational hypertension (3.0% vs. 1.2%) (all p<0.05). Multivariate analysis indicated that a history of PGDM independently predicted GDM recurrence (OR = 7.320, 95%CI: 5.473-9.791), gestational hypertension(OR = 2.924, 95% CI: 1.154-7.405), and reduced gestational age (OR = 0.88 per week, 95% CI: 0.792-0.981), while decreasing the risk ofPostpartum Anemia (OR = 0.694, 95% CI: 0.488-0.986). Neonatal outcomes showed no differences between groups. Conclusion: A history of PGDM significantly increases the risk of GDM recurrence and gestational hypertension in subsequent pregnancies, and is associated with earlier delivery gestational age. Notably, a history of PGDM is also associated with a reduced risk of postpartum anemia.