Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: Persistent macrosomia relates to maternal pre-pregnancy overweight

Abstract

After a 10-year program intending to improve glycemic control in diabetic pregnancies, we evaluated whether factors underlying macrosomia are similar for type-1 and -2 pregestational diabetic women. Patients and methods Twenty-three pregnancies in type-1 diabetics (PDM1, age 28.3 ± 1.1 years) and 51 pregnancies in type-2 diabetics (PDM2, age 32.8 ± 0.6 years) were followed and treated with intensified insulin therapy. Several factors potentially influencing macrosomia were evaluated. Statistics: chi-square, Fisher's exact, Student's “ t” and Mann–Whitney “ U” tests, and ROC analysis. Results In PDM1 and PDM2, respectively, large-for-gestational-age (LGA) frequencies were 26.08% and 37.25% (NS), antepartum HbA1c values were 6.5 ± 0.32 and 6.1 ± 0.16 (NS), and pre-pregnancy body mass indexes (BMI) were 23.03 ± 0.66 and 30.01 ± 0.89 (p < 0.0001). In PDM1 the main predictor of LGA was an antepartum HbA1c ≥ 6.8% ( p = 0.046), whereas in PDM2 pregestational BMI ≥ 24 the variable associated ( p = 0.032) with LGA newborns. Conclusions PDM1 and PDM2 differ in the underlying factors related to macrosomia. Whereas in PDM1 the antepartum HbA1c emerged as the most significant variable, suggesting that glycemic control largely determines macrosomia, in PDM2 with near-optimal glycemic control, macrosomia related to pregestational BMI.