Introduction: Gestational Diabetes Mellitus (GDM) is one of the pregnancy diseases with the highest rate of complications, influenced by several factors. Its prevalence has increased, with a prevalence of 7.2% in Portugal.
Objective: Characterize pregnant women with GDM and evaluate the perinatal outcomes according to the country of origin and previous GDM.
Material and methods: Cross-sectional and retrospective study. We collected clinical data and perinatal outcomes of 784 pregnancies followed at the endocrinology and diabetes clinic, from a central hospital, between 2012 and 2016. We excluded 43 cases due to lack of data or twin pregnancies. They were distributed by country of origin considering Portugal and 11 geographic regions according Statistics Division of the United Nations. The data were analyzed using SPSS software, differences were considered statistically significant when P<0.05. Results were presented as mean±standard deviation.
Results: In this population, mean age was 32.9±6.2 years and BMI was 27.0±5.7kg/m2. Fasting glycemia in the first trimester was 87.1±12.3 mg/dL. Oral glucose tolerance test (OGTT) was performed in 70.4% of pregnant women. Previous GDM (pGDM) and previous macrosomia occurred in 15.5% and 8.2% of cases, respectively. Insulin therapy was used in 52.0% and associated to higher BMI (64.3% were overweight or obese, P=0.001) and pGDM (Odds ratio (OR) 1.8; 95%confidence interval (CI) 1.22.7, P=0.005). The gestational age at birth was 38.3±1.6 weeks, birthweight was 3147.9±529.4 g and 3.6% of newborns were macrosomic. Previous macrosomia and pGDM were related to macrosomia, with a relative risk of 6.3 (95%CI 3.013.1, P=0.001) and 2.7 (95%CI 1.25.8, P=0.01), respectively. Neonatal morbidity occurred in 23.6% and depended on mothers BMI (P=0.027) and pGDM (P=0.006) and was not different between regions. Hyperbilirubinemia was the most frequent neonatal morbidity in 18.2% of cases. We found statistically significant differences between geographic regions in fasting glycemia of OGTT (the highest value in Middle Africa women: 93±15.3 mg/dL, P=0.001), in BMI (the highest value in Middle Africa women: 28.4±5.3, P=0.04), in occurrence of hydramnium (the highest frequency occurred in Southern Asia women with 14.3%, P=0.002) and in birthweight (newborns of Western Europe women had a higher weight 3550.0±869.1 g, P=0.009).
Conclusion: Based on the analysis performed, the country of origin didnt influence the majority of perinatal outcomes and previous GDM was the factor that most influenced these results. Pregnant women with previous DMG may benefit from targeted interventions to improve outcomes.
18 - 21 May 2019
European Society of Endocrinology