Gestational diabetes mellitus and obesity: effects on offspring

Abstract

Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) combined with GDМ and maternal obesity.Materials and Methods. А retrospective observational case-control non-combined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250 women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, as well as somatic health was carried out. Patients from the main group were subdivided into smaller groups: 1А (n = 77) – mothers whose newborns postnatally exerted adverse perinatal outcomes associated with impacting maternal hyperglycemia, and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess an effect of maternal hyperglycemia on formation of perinatal CNS lesions. Pre-labor concentration of neuron-specific enolase (NSE) was measured in the amniotic fluid of full-term fetuses in the group of pregnant women with GDM (n = 33) and in the group of pregnant women lacking carbohydrate metabolism disorders (n = 42).Results. Obesity, late reproductive age, family history of type 2 diabetes mellitus, abortions, early reproductive losses, macrosomic delivery in history are the main risk factors for GDM development. An algorithm was developed that allowed to predict a risk of newborn perinatal pathology in mother with GDM with an overall percentage of correct predictions of 68.7 ± 3.8 %. Pre-labor concentration of NSE in the amniotic fluid of full-term fetuses was elevated by 1.68 times (p = 0.006) in women with combined GDM and obesity (5.56 [3.37–6.24] ng/ml) compared to pregnant women with normal weight lacking carbohydrate metabolism disorders (3.29 [1.49–4.89] ng/ml).Conclusion. Pregnant women with obesity and type 2 diabetes mellitus familial history were featured with most prominent potential of developing perinatal complications. Rise in amniotic fluid NSE level in patients with GDМ corroborates damage of fetal CNS during antenatal period. The maximum NSE level was found in women comorbid with GDM and obesity.