Abstract
Gestational diabetes mellitus (GDM) is associated with a higher risk of perinatal morbidity and mortality, and its main complication is the occurrence of large for gestational age (LGA) newborns. The present study aims to characterize pregnant women with GDM and to identify factors associated with the occurrence of LGA newborns in this population. A cross-sectional study was performed based on medical records of women whose prenatal care and delivery were performed at the Maternal and Child Unit of the Hospital Universitário of the Universidade Federal do Maranhão, state of Maranhão, Brazil. A total of 116 pregnant women diagnosed with GDM were included according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The variables associated with LGA newborns after multivariate analysis were: obesity prior to pregnancy (OR = 11.6; 95% CI: 1.40-95.9), previous macrosomia (OR = 34.7; 95% CI: 4.08-295.3), high blood glucose levels in the 3rd trimester (OR = 2,67; 95% CI: 1.01-7.12) and combined change in the oral glucose tolerance test (OGTT) (fasting + postdextrose) (OR = 3.53; 95% CI: 1.25-14.2) = 1.17-10.6). Otherwise, insufficient weight gain during pregnancy reduced the risk for LGA newborns (OR = 0.04; 95% CI: 0.01-0.32). Obesity prior to pregnancy, previous macrosomia, high blood glucose levels in the 3rd trimester, and combined change in the OGTT were independent predictive factors for LGA newborns in pregnant women with GDM.
Highlights
Gestational diabetes mellitus (GDM) is classically defined as glucose intolerance resulting in hyperglycemia of variable intensity, with onset or first recognition during pregnancy, which may or may not persist after childbirth.[1]Gestational diabetes mellitus is usually diagnosed through provocative tests using glucose loads
The present study aims to characterize pregnant women with GDM and to identify factors associated with the occurrence of large for gestational age (LGA) newborns in this population
This study showed that weight gain (WG) below that recommended by the Institute of Medicine (IOM) was a protective factor for the outcome of LGA newborns, but it is necessary to consider the small sample and the limited statistical power of this analysis
Summary
Gestational diabetes mellitus (GDM) is classically defined as glucose intolerance resulting in hyperglycemia of variable intensity, with onset or first recognition during pregnancy, which may or may not persist after childbirth.[1]. Gestational diabetes mellitus is usually diagnosed through provocative tests using glucose loads. In 2010, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) suggested a new diagnostic criteria based on the 75 g oral glucose tolerance test (75-g OGTT) – performed between 24 and 28 weeks of gestation, with plasma glucose measured at baseline (fasting), after 1 hour, and after 2 hours, wherein one altered measurement The prevalence of GDM is quite variable, depending on the population under study and on the diagnostic criteria. According to the IADPSG criteria, the prevalence of GDM significantly increased by up to between 15 and 20%.2. The higher the degree of maternal obesity, the greater the risk of developing GDM, primarily because of insulin resistance.[7,8]
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