Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1 st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1 st T (rs = 0.213, p = 0.001) and 2 nd T (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia ), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1 st T, fasting hyperglycemia in 2 nd T and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.
BackgroundControversy exists regarding risk factors in pregnant women that might be associated with a higher probability of failure of lifestyle intervention in the treatment of gestational diabetes (GD). These pregnant women's risk factors may highlight the need for closer surveillance at an early stage of pregnancy. AimsTo identify predictors of pharmacological therapy need in early and late GD. MethodsThis was a retrospective observational study including women with GD diagnosed in the first (group 1) or second trimester (group 2) according to the criteria proposed by the International Association of Diabetes Pregnancy Study Group (IADPSG), singleton pregnancy and follow-up between January 2015 and December 2018, divided according to treatment (lifestyle intervention or pharmacological treatment (metformin and/or insulin)). ResultsA total of 278 and 273 women were included in groups 1 and 2, of which 48.6% and 55.3% underwent nonpharmacological treatment, respectively. In group 1, women requiring pharmacological therapy tended to be older and have previous GD or family history of diabetes, higher body mass index (BMI) and higher fasting blood glucose (FBG) levels. In group 2, pharmacological treatment need was associated with multiparity, previous GD, higher BMI, higher fasting glucose value in the oral glucose tolerance test (OGTT), and higher OGTT value at 60 minutes.The independent risk factors identified for pharmacological treatment requirement were maternal age (OR 1.10 (1.05-1.16), p<0.001), previous GD (OR 2.70 (1.10-6.58), p=0.029) and FBG (OR 1.07 (1.00-1.14), p=0.048) in group 1 while BMI (OR 1.07 (1.02-1.13), p=0.012) and fasting glucose value in the OGTT (OR 1.03 (1.01-1.05), p=0.006) were the factors identified in group 2. The cut-off values for FBG and fasting glucose value in the OGTT that predicted the necessity of pharmacological treatment were 95.50 mg/dL and 88.50 mg/dL, respectively. ConclusionsIn early GD, closer surveillance is necessary for older women with a previous GD and an FBG ≥ 95.50 mg/dL. In late GD, pre-gestational BMI and a fasting glucose value in the OGTT ≥ 88.50 mg/dL should prevail.
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