Introduction: Gestational diabetes mellitus (GDM) is a carbohydrate intolerance with onset or recognition during pregnancy. Timely screening and proper management of this condition is essencial to maximize pregnancy and neonatal outcomes.
Methods: Retrospective analysis of all cases of GDM, and the respective new-borns, followed in our obstetrics unit between 2012 and 2015. Clinical and workup parameters were evaluated.
Results: From a total of 644 cases of GDM, median age was 33, median BMI was 27 (overweight/pre-obese) and the most common academic qualifications was a licentiate degree (13 years of school). In terms of risk factors, 51% had a family history of DM and a personal history of: GDM (11%), macrossomia (4%), hydramnios (3%), fetal malformations (5%) and fetal death (0.3%). With respect to pregnancy and maternal complications we verified that 7% had hypertension diagnosis during pregnancy, 4% had one or more urinary tract infection and 11% had preterm birth. The labour was induced in 36% of the times, and we had a 37% caesarean rate, 20% of dystocic deliveries and an eutocic delivery in 43%. Neonatal outcomes consisted of a morbidity rate of 22% and 0.5% mortality rate (3 cases). Pharmacological management was necessary in 38% (35% insulin vs 3% metformin).
Conclusions: There is no denying that GDM is increasing worldwide. From an obstetric perspective this is probably related with the increased mother weight (obesity epidemic) and the delayed age for the first pregnancy (social motives), which are represent at our casuistic. Not long ago, GDM management was a dichotomy that consisted of lifestyle changes (diet and physical exercise) or insulin therapy. Nowadays, for selective cases we can also add to our therapeutic arsenal metformin, which was contraindicated in the past. At our maternity the metformin therapy was implemented in 17 cases on 2014 and 2015, translating this new tendency.
20 - 23 May 2017
European Society of Endocrinology