Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy.

M Caputo,G Giachetti,G Aimaretti,P Marzullo,M T Samà,M Zavattaro,V Antoniotti,T Daffara,I Leone,A De Pedrini,A Ferrero,D Longo,V Remorgida,F Prodam,V Bullara,C Mele,Christian S Goebl

doi:10.1155/2021/9474805

Abstract

Aim To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. Methods We retrospectively analyzed data from 586 women referring to our unit (2015–2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). Results 43.2% of women came from HMPC; they were younger (p < 0.0001) and required insulin treatment more frequently than Caucasian women born in Italy (χ2 = 17.8, p=0.007). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016–1.060, p=0.005; OGTT T120: OR = 1.01, CI 95% 1.002–1.020, p=0.02; BMI: OR = 1.089, CI 95% 1.051–1.129, p < 0.0001). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145–3.612, p=0.016). We did not find any association between ethnicities and neonatal/maternal complications. Conclusions In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.

Highlights

Gestational diabetes mellitus (GDM) is the most common endocrinological disorder during pregnancy, with a prevalence of 4–12% [1]
We retrospectively investigated clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasian women born in Italy and High Migration Pressure Countries (HMPC) and affected by GDM
HMPC women were younger, confirming findings of other studies conducted in Italy [16] and required more frequent insulin treatment than Caucasian women born in Italy

Summary

Introduction

Gestational diabetes mellitus (GDM) is the most common endocrinological disorder during pregnancy, with a prevalence of 4–12% [1]. According to the most recent classification, GDM has been defined as a condition of hyperglycemia occurring in the second or third trimester of pregnancy after excluding pregestational diabetes mellitus [2]. The pathogenesis of GDM is related to a mother’s relative beta-cell failure in respect to the pregnancy insulin resistance. The increase of placental hormones antagonizes insulin action in the second and third trimesters of pregnancy, leading to insulin resistance. Because women with GDM have a blunted suppression of the endogenous glucose production that results into a postabsorptive hyperglycemia, the 75 g oral glucose tolerance test (OGTT) is the gold standard for the diagnosis [2].

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Conclusion