Endocrine Abstracts

Introduction: A retrospective study of the year 2003, of 1314 women with GDM, from 24 public health Centres in Portugal, was performed.

Patients and methods: Women were divided into two groups according to their pre-pregnancy BMI: group Go – BMI ≥30 kg/m² and group Gno BMI <30 kg/m². The mean age of these women was 32.9±5 years (18–45), the A1c was <6% in both groups. The influence of the BMI in different variables was analysed: family history of DM, weight gain during pregnancy according to the recommendation of the Institute of Medicine – Washington 1990, blood pressure, need of insulin therapy, gestation age at the beginning of insulin therapy, time of delivery, type of delivery, new-born weight and the re-evaluation post-partum.

Results: The mean BMI was 26.7±5.1 (16–49.7), 76.3% had BMI <30 and 23.8% had BMI ≥30. Patients with a family history of DM had higher mean BMI (26.93 kg/m²), than those without family history (26.19 kg/m²) – P=0.01. The weight gain during gestation was adequate in 41.4%, reduced in 29.9% and excessive in 28.7% of the patients. The prevalence of normal arterial blood pressure was 86.5%, hypertension worsened by pregnancy was 6.9% and pregnancy induced hypertension was 6.6%, the mean BMI in these three groups were 26.1, 30.51 and 29.33, respectively (P<0.05). There was statistical significant difference (P<0.05) between the two groups in these parameters: Insulin therapy 75.2% in Go vs 52.5% in Gno and its need was earlier in Go -28.83 wks vs Gno -30.97 wks; time of delivery 38.1 wks in Go vs 38.4 wks in Gno; caesarean section 49.8% in Go vs 35% in Gno; new- born weight 3324.8 g in Go vs 3167.9 g in Gno; macrosomic babies 8.3% in Go vs 4.4% in Gno. In the re-evaluation post-partum we found that higher BMI were related with severe degrees of carbohydrate intolerance: the mean BMI in the DM group was 29.53, in the IGT was 28.16, in the IFG was 26.99 and in the NGT was 26.55, P<0.05. We didn’t find any difference in the re-evaluation between the women with adequate and excessive weight gain.

Conclusions: In GDM, obesity was found to be an increased risk for hypertension, earlier insulin need, earlier delivery, caesarean delivery, high baby weight and macrosomic babies. Pre-pregnancy BMI has a positive correlation with the development of carbohydrates intolerance. Thus we conclude that obesity in GDM is a risk factor for maternal and fetal outcomes, with the risk of early development in the mother of glucose intolerance.