Introduction: Due to the growing prevalence of obesity, more women are overweight in early pregnancy, leading to adverse neonatal and obstetric outcomes.
Objective: To evaluate the influence of maternal prepregnancy body mass index (BMI) on blood glucose levels at diagnosis of gestational diabetes (GD), obstetric and neonatal outcomes.
Methods: Retrospective observational study including women with GD and singleton pregnancy, with follow-up at Baixo Vouga Hospital Center between January 2015 and June 2018. Statistic analysis: SPSS 24.
Results: Sample of 462 pregnant women, medium age 32.65 years (SD 5.45) and medium BMI 27.29 kg/m2 (SD 5.57), with no differences in terms of history of macrosomia and GD between maternal BMI groups. Only in pregnant women with normal BMI the percentage of familiar history of GD was less than 50% (P 0.001). In respect to the trimester (T) of diagnosis of GD, 53.7% of women with normal BMI and 55.8% with BMI>30 Kg/m2 were diagnosed in the 1stT (P 0.011). BMI positively and significantly correlated with fasting glucose level (FGL) in the 1stT (r=0.213, P 0.001) and 2ndT (r=0.210, P 0.001), despite not correlating with glucose level at 60 and 120. In what weight gain was concerned, 44.9% women with pre-obesity and 40.2% with BMI>30 Kg/m2 had excessive weight gain (P<0.05) and 65.1% of them required pharmacological treatment (P 0.05). There were no differences between groups in terms of pre-eclampsia, hydramnios and prematurity, but gestational hypertension was more frequent in obese women (P 0.004). Although there were no differences in neonatal morbidity, the majority of cesareans (40.3%; P<0.05) and large-for-gestational age (LGA) birthweight (50%; P 0.035) occurred in women with BMI>30 Kg/m2. By adjusting for maternal age on logistic regression, BMI had a predictive value only for macrosomia (aOR 1.177 (1.0061.376) P 0.041). BMI and weight gain are positively correlated with weight at birth (r=0.132 P 0.005 e r=0.188 P 0.005) but not with gestational age.
Conclusion: Maternal obesity is related with a major probability of diagnosis of GD in 1stT and fasting hyperglycemia in 2ndT, a consequence of the associated insulin resistance. Those women require, more frequently, pharmacological therapy and, similarly to previous studies, are associated with gestational hypertension, cesarean delivery and fetal macrosomia. In these women, there was no increase in the number of stillbirth, pre-eclampsia or neonatal morbidity.
18 - 21 May 2019
European Society of Endocrinology