Profile of Pregnant Women with Gestational Diabetes Mellitus at Increased Risk for Large for Gestational Age Newborns

Abstract

Objective 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. Methods 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). Results 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). Conclusion 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.

Gestational and Previous Diabetes in Pregnancy: Perinatal Results

“…The highest likelihood of macrosomia development was observed in pregnant women with increased blood glucose levels (p < 0.05). These results are consistent with the ones reported by Rodrigues et al [31], who found that high blood glucose levels are independent predictors of weight gain in infants born from diabetic mothers.…”

“…Urinary tract infection (n = 3; 3.4%), hypoglycemia (n = 2; 2.27%), polyhydramnios (n = 2; 2.27%), vaginitis (n = 4; 4.54%), pre-eclampsia (n = 4; 4.54%) and chronic fetal distress with IUGR (n = 2; 2.27%) were the secondary outcomes identified during prenatal followups. These findings are compatible with data available in the medical literature [28][29][30][31][32]34,35].…”

Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes

“…It is a known fact that poorly controlled GDM, pre-pregnancy obesity and excessive weight gain during pregnancy increase the risk of LGA and several other neonatal complications (2,11,(19)(20)(21). Several studies have reported that previous macrossomia history, prepregnancy obesity and weight gain during pregnancy above the recommended guidelines are associated with an increased incidence of LGA (22)(23)(24)(25)(26). Dong and cols.…”

Ganho ponderal e estado nutricional de mulheres portadoras de diabetes mellitus gestacional

“…Pesquisas nacionais e internacionais com DMG, identificaram excesso de peso em período pré-gestacional, com variação de 47,8% a 74% (Guerra et al, 2018;Larrabure-Torrealva et al, 2018;Machado et al, 2019;Tavares et al, 2019).…”

“…Em relação ao ganho ponderal excessivo, a literatura mostra variação de 26,1% a 35,4%, com maiores valores em mulheres com sobrepeso e obesidade pré-gestacional (36,7% e 36,9%) respectivamente. Ao mesmo tempo que gestantes de baixo peso (48,3%) e eutróficas (50,2%), podem apresentar ganho ponderal abaixo do recomendado (Machado et al, 2019;Tavares et al, 2019). Ademais foi observada associação estatística significante entre o ganho ponderal e o estado nutricional prévio no estudo de Machado et al (2019); fato não observado no presente estudo.…”