Gestational diabetes and pre‐pregnancy overweight: Possible factors involved in newborn macrosomia

Abstract

Abstractj og_1681 208..214Aim: Good glycemic control in gestational diabetes mellitus (GDM) seems not to be enough to prevent macrosomia (large-for-gestational-age newborns). In GDM pregnancies we studied the effects of glycemic control (as glycosylated hemoglobin [HbA1c]), pre-pregnancy body mass index (PP-BMI) and gestational weight gain per week (GWG-W) on the frequency of macrosomia. Methods: We studied 251 GDM pregnancies, divided into two groups: PP-BMI < 25.0 kg/m 2 (the nonoverweight group; n = 125), and PP-BMI Ն 25.0 kg/m 2 (the overweight group; n = 126). A newborn weight Z-score > 1.28 was considered large-for-gestational-age. Statistical analysis was carried out using the Student's t-test and c 2 -test, receiver-operator characteristic curves and linear and binary logistic regressions. Results: Prevalence of macrosomia was 14.9% among GDM (n = 202/251, 88.4%) with good glycemic control (mean HbA1c < 6.0%), and 28.1% in those with mean HbA1c Ն 6.0% (n = 49/251, P < 0.025). Macrosomia rates were 10.4% in the non-overweight group and 24.6% in the overweight group (P = 0.00308), notwithstanding both having similar mean HbA1c (5.48 Ϯ 0.065 and 5.65 Ϯ 0.079%, P = 0.269), and similar GWG-W (0.292 Ϯ 0.017 and 0.240 Ϯ 0.021 kg/week, P = 0.077). Binary logistic regressions showed that PP-BMI (P = 0.012) and mean HbA1c (P = 0.048), but not GWG-W (P = 0.477), explained macrosomia. Conclusions: Good glycemic control in GDM patients was not enough to reduce macrosomia to acceptable limits (<10% of newborns). PP-BMI and mean HbA1c (but not GWG-W) were significant predictors of macrosomia. Thus, without ceasing in our efforts to improve glycemic control during GDM pregnancies, patients with overweight/obesity need to be treated prior to becoming pregnant.

Effects of pre-pregnancy weight on incidence of large for gestational age newborn in pregnant women with gestational diabetes mellitus

“…In a systematic review, the association between gestational weight gain and birth weight was observed despite the use of different standard references and various methods of characterizing gestational weight gain (total, rate, or by trimester) [14]. This was consistent with the results among GDM pregnant women in this study.…”

“…However, there are still limited information on association between pre-pregnancy weight and birth weight among GDM women [13][14][15].…”

Gestasyonel Diabetes Mellitusta Gebelik Oncesi Vucut Agirliginin Yenidoganin Dogum Agirligina Etkisinin Incelenmesi

“…Son yıllarda yapılan az sayıda çalışmada, gebelik öncesi BKİ'nin neonatal doğum ağırlığına etkisinin en az maternal hiperglisemi kadar önemli olduğu gösterilmiştir (10,11 Olmos ve ark. yaptığı çalışmada ise gebelik öncesi BKİ'nin 25 kg/m 2 ve üzerinde olmasının makrozomi ve iri bebek için maternal hiperglisemiden daha kuvvetli bir belirleyici olduğunu göstermiştir (12). Bu çalışmaya dahil edilen gebelerin de iyi glisemik kontrollü oldukları görüldü, ancak glisemik kontrol açısından üç grup arasında fark olmamasına rağmen iri bebek doğurma sıklığı fazla kilolu ve obez grupta literatür ile benzer şekilde daha fazlaydı.…”

La hipótesis de Pedersen no es suficiente: Otros nutrientes además de la glucosaexplicarían la macrosomía fetal enpacientes diabéticas gestacionales consobrepeso y buen control glicémico

“…Desde 1964, cuando la DMG emergió como subtipo de la diabetes mellitus (DM) 21 , la hipótesis de Pedersen fue aplicada a la DMG, de modo que el tratamiento de esta entidad ha consistido desde entonces en reducir los valores de glicemia materna, apuntando a un control glicémico óptimo, definido actualmente como glicemia en ayunas 70-90 mg/dl, pre-prandiales de 70-105 mg/dl, y 1 h postprandial 90-120 mg/dl [22][23][24] . Sin embargo, como veremos más adelante, parece ser insuficiente para evitar la macrosomia fetal.…”

“…En un estudio publicado recientemente, demostramos que la tasa de recién nacidos GEG fue de 18%, en 251 embarazadas con DMG a pesar de un óptimo control glicémico 24 . Al clasificar las madres en dos grupos según su índice de masa corporal (IMC) pregestacional, las tasas de GEG fueron de 10% para el grupo sin sobrepeso y de 25% para las madres con sobrepeso pregestacional, a pesar que ambos grupos presentaban valores de glicemia media y de hemoglobina glicosilada similares al final del embarazo.…”