Predicting macrosomic newborns using postprandial glycemia of pregnancy in diabetic women

Abstract

To determine the mean two-hour postprandial (2hPP) blood glucose level and to analyze the maternal variables that can predict macrosomic or large for gestational age (LGA) newborns in diabetic mothers such as the type of diabetes mellitus, pre-gestational body mass index (BMI), previous macrosomic newborn, and parity. Materials and Methods: A prospective, longitudinal study was conducted with 200 pregnant women who had either gestational (103) or pre-gestational (97) diabetes. The mean 2hPP blood glucose levels, which were obtained by capillary glycemia, were calculated for all pregnant women >24 weeks gestation and divided into three groups: group 1 ≤100 mg/dl, group 2 100-120 mg/dl, and group 3 ≥120 mg/dl. The analysis of variance (ANOVA) was used to investigate the differences between groups for the occurrence of macrosomia or LGA. The receiver operator characteristics (ROC) curve was used to identify the significant cutoff point for the mean level of 2hPP blood glucose. Results: Pre-gestational BMI and previous macrosomia were associated with the occurrence of newborns with weight alterations of 32.8% and 35.7%, respectively (p <0.001). However, other independent variables such as multiparity, lipid profile (total cholesterol and triglycerides, both isolated and associated), and type of diabetes were assessed both isolated and grouped. The best cutoff point for 2hPP blood glucose was >109 mg/dl, with a sensitivity of 81%, specificity of 40%, positive predictive value of 27.8%, and negative predictive value of 88.1%. Conclusion: Macrosomic and LGA were associated with maternal 2hPP blood glucose values > 109 mg/dl between 24 and 34 weeks gestation.