Postpartum infectious morbidity in patients with medication-controlled gestational diabetes mellitus: a retrospective cohort study

CONTEXT: Gestational diabetes mellitus (GDM) has been associated with increased infectious morbidity antenatally. However, it is unclear whether the risk of infections in this population remains elevated postpartum. OBJECTIVES: The objective of this study was to evaluate whether medication-controlled gestational diabetes mellitus (A2GDM) increases the risk for infectious morbidity in the postpartum period. METHODS: This is a retrospective cohort study that was conducted from January 1, 2010 to October 31, 2023, evaluating 46,756 singleton pregnancies across a healthcare system. We evaluated whether patients with A2GDM have a higher risk for infection in the postpartum period (within 6 weeks) as compared to patients without GDM. Composite infectious morbidity was the primary outcome: this included surgical site infection (SSI), bacterial vaginosis, vaginal candidiasis, urinary tract infection, mastitis, and postpartum endometritis. Secondary outcomes included 30-day readmission for obstetrical reasons or gynecologic surgery. RESULTS: Patients with A2GDM did not have an increase in infectious complications in the postpartum period as compared to patients without GDM (odds ratio [OR] 1.17, confidence interval [CI] 0.96-1.42). There was no increased risk of being admitted due to an obstetrical reason (OR 1.37, CI 0.86-2.18) or for gynecologic surgery (OR 1.00, CI 0.65-1.53). CONCLUSIONS: Patients with A2GDM did not have a greater risk of an infectious complication or readmission for obstetrical or gynecologic indications in the postpartum period compared to patients without GDM. Thus, it is unlikely that glucose testing in the postpartum period will be beneficial to help prevent infectious morbidity.