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 (1845), 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 (1649.7), 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 didnt 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.
03 - 07 May 2008
European Society of Endocrinology