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

Tavares, Maria da Glória Rodrigues; Lopes, Érika Sales; Barros, Rosy Anne de Jesus Pereira Araújo; Azulay, Rossana Santiago de Sousa; Faria, Manuel dos Santos

doi:10.1055/s-0039-1687860

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 41 (05) • May 2019 • https://doi.org/10.1055/s-0039-1687860 copy

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

Perfil de gestantes com Diabetes Mellitus Gestacional com maior risco para recém-nascidos grandes para a idade gestacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 HospitalUniversitário of theUniversidade Federal doMaranhão, state of Maranhão, Brazil.A total of 116 pregnant women diagnosed with GDMwere 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, insufficientweight 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.

Keywords:
gestational diabetes mellitus; oral glucose tolerance test; large for gestational age

Variables	Totaln= 116	Pre-gestational BMI			p-value
Variables	Totaln= 116	Normaln= 32	Overweightn= 35	Obesityn= 49	p-value
Age (years old)	32.7 ± 6.4	30.9 ± 7.1	33.6 ± 5.4	33.2 ± 6.3	0.158
Height(cm)	156 ± 6	156 ± 7	155 ± 5	157 ± 5	0.178
Multiparous (%)	25.0%	12.5%	20.0%	36.7%	0.101
Weigth gain (kg)	9.5 ± 6.9	12.9 ± 5.3	9.5 ± 6.4	7.3 ± 7.4**	0.001*
Categories of weigth gain (%)					0.731
Insufficient	33.6%	40.6%	37.1%	26.5%
Appropriate	31.0%	28.1%	28.6%	34.7%
Excessive	35.4%	31.3%	34.3%	38.8%
OGTT values (mg/dl)
Fasting	95.6 ± 14.6	89.6 ± 12.0	98.2 ± 16.9**	97.6 ± 13.3**	0.021*
60 minutes	187.8 ± 34.5	184.7 ± 31.0	198.1 ± 42.2	183.0 ± 30.1	0.202
120 minutes	172.1 ± 35.1	160.4 ± 31.3	185.8 ± 36.4**	169.7 ± 33.7	0.009*
Number of points changed in OGTT (%)					0.255
1 point	37.1%	53.1%	28.6%	32.6%
2 points	37.9%	31.3%	42.8%	38.8%
3 points	25.0%	15.6%	28.6%	28.6%
Categories changed in OGTT					0.084
Only fasting	12.9%	18.7%	5.7%	14.3%
Only after dextrose load	36.2%	50.0%	34.3%	28.6%
Fasting and after dextrose load	50.9%	31.3%	60.0%	57.1%
Insulin therapy (%)	43.1%	28.1%	54.3%	44.9%	0.091
Mean fasting blood glucose during 3^rd trimester (mg/dl)	90.8 ± 15.3	85.1 ± 12.0	91.8 ± 17.1	93.8 ± 15.2**	0.048*
Delivery (%)					0.991
Normal	25.0%	25.0%	25.7%	24.5%
Cesarean	75.0%	75.0%	74.3%	75.5%

Variables	Totaln= 116	Pregestational BMI			p-value
Variables	Totaln= 116	Normaln= 32	Overweightn= 35	Obesityn= 49	p-value
Gender (%)					0.538
Male	47.4%	53.1%	40.0%	49.0%
Female	52.6%	46.9%	60.0%	51.0%
Post-term pregnancy (%)	12.9%	15.6%	8.5%	14.3%	0.645
GA at birth (weeks)	38.1 ± 1.5	38.3 ± 1.3	37.5 ± 1.9	38.2 ± 1.1	0.072
Weight at birth(g)	3342 ± 534	3092 ± 348	3319 ± 592	3523 ± 530**	0.001*
Macrossomia (%)	11.2%	0%	14.3%	16.3%**	0.037*
LGA (%)	25.9%	3.1%	28.6%**	38.8%**	0.001*

Variables	LGA (Percentil >90)
Variables	%	Crude OR(95% CI)	p-value	Adjusted OR (95% CI)	p-value
Previous macrossomia
No	17.5	Ref.		Ref.
Yes	92.3	56.7 (6.92–463.8)	< 0.001*	34.7 (4.08–295.3)	0.001*
Pregestational BMI
Normal	3.1	Ref.		Ref.
Overweight	28.6	12.4 (1.48–103.5)	0.006*	6.53 (0.62–68.5)	0.117
Obesity	38.8	19.6 (2.41–155.9)	< 0.001*	11.6 (1.40–95.9)	0.023*
Categories of weigth gain
Insufficient	7.7	0.11 (0.03–0.45)	< 0.001*	0.04 (0.01–0.32)	0.001*
Appropriate	41.7	Ref.		Ref.
Excessive	29.3	0.57 (0.22–1.48)	0.368	0.39 (0.11–1.37)	0.142
Number of points changed in OGTT (%)
1 point	16.3	Ref.		Ref.
2 points	27.3	1.92 (0.67–5.49)	0.327	1.05 (0.29–3.75)	0.932
3 points	37.9	3.14 (1.04–9.47)	0.037*	1.86 (0.38–9.03)	0.440
Categories changed in OGTT
Only fasting	13.3	0.92 (0.16–5.16)	1.000	1.11 (0.16–7.38)	0.912
Only after dextrose load	14.3	Ref.		Ref.
Fasting and after dextrose load	37.3	3.56 (1.29–9.82)	0.020*	3.53 (1.17–10.60)	0.024*
Mean fasting blood glucose during 3^rd trimester (mg/dl).
> 95 mg/dL	41.7	3.07 (1.25–7.53)	0.022*	2.67 (1.01–7.12)	0.048*
< 95 mg/dL	18.8	Ref.		Ref.

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Maria da Glória Rodrigues Tavares, MsC, Rua Almirante Tamandaré, 1, 65020-600, Centro, São Luís, MA, Brasil (e-mail: madagloria@gmail.com).