Maternal factors associated with hyperglycemia in pregnancy and perinatal outcomes: a Brazilian reference center cohort study

Bianca F Nicolosi,José E Corrente,Iracema M P Calderon,Jose G Cecatti,Marilza V C Rudge,Claudia G Magalhães,Roberto A Costa,Joice M Vernini

doi:10.1186/s13098-020-00556-w

Abstract

BackgroundWhile sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP). The objective of this study is to identify independent risk factors for HIP and its adverse perinatal outcomes in a Brazilian public referral center.MethodsWe included 569 singleton pregnant women who were split into three groups by glucose status: GDM (n = 207), mild gestational hyperglycemia (MGH; n = 133), and control (n = 229). Women who used corticosteroids or had a history of DM were excluded. HIP comprised both GDM and MGH, diagnosed by a 100 g- or 75 g-oral glucose tolerance test (OGTT) and a glucose profile at 24–28 weeks. Maternal characteristics were tested for their ability to predict HIP and its outcomes. Bivariate analysis (RR; 95% CI) was used to identify potential associations. Logistic regression (RRadj; 95% CI) was used to confirm the independent risk factors for HIP and its perinatal outcomes (p < 0.05).ResultsAge ≥ 25 years [1.83, 1.12–2.99], prepregnancy BMI ≥ 25 kg/m2 [2.88, 1.89–4.39], family history of DM [2.12, 1.42–3.17] and multiparity [2.07, 1.27–3.37] were independent risk factors for HIP. Family history of DM [169, 1.16–2.16] and hypertension [2.00, 1.36–2.98] were independent risk factors for C-section. HbA1c ≥ 6.0% at birth was an independent risk factor for LGA [1.99, 1.05–3.80], macrosomia [2.43, 1.27–4.63], and birthweight Z-score > 2.0 [4.17, 1.57–11.10].ConclusionsMGH presents adverse pregnancy outcomes similar to those observed in the GDM group but distinct from those observed in the control (no diabetes) group. In our cohort, age ≥ 25 years, prepregnancy BMI ≥ 25 kg/m2, family history of DM, and multiparity were independent risk factors for HIP, supporting the use of selective screening for this condition. These results should be validated in populations with similar characteristics in Brazil or other low- and middle-income countries.

Highlights

While sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP)
Diabetes in pregnancy (DIP) is hyperglycemia diagnosed in early pregnancy using WHO diagnostic criteria for nonpregnant women; GDM is diagnosed in the second and third trimesters of pregnancy using IADPSG criteria based on the risk of adverse perinatal results [1,2,3]
GDM is the most common metabolic disorder that occurs during pregnancy, and it is associated with adverse shortand long-term effects on both the mother and offspring and an increased risk for future type 2 diabetes mellitus (T2DM), metabolic syndrome (MS) and cardiovascular disease (CVD) [4,5,6,7]

Summary

Introduction

While sufficient evidence supporting universal screening is not available, it is justifiable to look for specific risk factors for gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy (HIP). Regardless of normal OGTT, the abnormal GP test indicated hyperglycemia in some pregnant women; when hyperglycemia was untreated, the perinatal mortality rate was 4.16%, which is similar to the rate observed in the GDM group and ten times greater than that observed in the nondiabetic control group. These cases are subjected to strict glucose control, similar to diabetes in pregnant women, and are classified as mild gestational hyperglycemia (MGH) [9, 10]

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