Introduction: Effective gestational diabetes mellitus (GDM) management is pivotal for reducing delivery complications for both mother and offspring, since a linear and continuous association between blood glucose and unfavorable outcomes has been extensively reported. The aim of present study was to investigate possible factors affecting GDM treatment goals.
Methods: We retrospectively evaluated 136 consecutive patients with GDM, treated in our department from January 2013 to December 2018, with median(range) age 31.5(1943) years, diagnosed at 27.5(637) week of gestation and mixed nationality (68 Greek, 44 other Europid, 19 Middle East, 5 Africans). Previous personal and family medical history was collected, while demographic, clinical and pregnancy outcomes for mother and offspring were also recorded.
Results: GDM diagnosis was made from fasting glucose in 4.5% and from OGTT with 75gr. glucose in 95.5% of patients. Body mass index (BMI) in overall sample was 30.3 (2147). Non-Greek women had lower BMI values (Spearmans rho=−0.22, P=0.017). Seventy-four (54.5%) were treated with diet only and 62 (45.5%) were treated with insulin plus diet. Previous GDM was reported in 21.82%. In overall sample median treated fasting glucose was 88 (69130)mg/dl and median treated 1hour post-prandial glucose was 112 (87180)mg/dl. Based on universally accepted target mean fasting (<95 mg/dl) and mean 1hour post-prandial (<140 mg/dl) self-assessment glucose values, 83% of patients were characterized as adequately treated, whereas 17% were outside treatment goals and formed the two treatment groups. Number of monthly prenatal visits was strongly associated with adequate treatment (rho=0.70, P<0.001). No significant difference in offspring weight was found between groups [Mann-Whitney U-test 3127gr. vs 3377gr., P=0.38, overall median(range) 3125(15504000)gr.]. No differences in complication rates were also recorded between groups. More patients outside treatment goals were recorded in insulin treated group (43.18% vs 72.2%, P=0.023). Gravida status tended to be positively associated with adequate treatment (rho=0.19, P=0.062). Positive patients mother family history for type 2 diabetes was strongly associated with outside treatment goals (rho=−0.26, P=0.008) and also positively associated with higher BMI values (rho=0.20, P=0.041).
Conclusions: Regular, at least four, monthly prenatal visits are associated with optimal GDM management. Patient education is necessary and crucial from the first visit in order to maintain compliance. Positive patients mother family history for type 2 diabetes is associated with higher BMI and higher fasting and post-prandial glucose values.
18 - 21 May 2019
European Society of Endocrinology