Gestational weight gain in women with type 1 and type 2 diabetes mellitus is related to both general and diabetes-related clinical characteristics.

PURPOSE: To assess predictors of gestational weight gain (GWG), according to the Institute of Medicine (IOM) 2009, in women with type 1 and type 2 diabetes. METHODS: This was a retrospective cohort study conducted at a tertiary center. GWG based on the IOM was assessed both uncorrected and corrected for gestational age. General and diabetes-related clinical characteristics were analyzed as predictors. RESULTS: We evaluated 633 pregnant women with type 1 and type 2 diabetes. GWG uncorrected for gestational age was inadequate (iGWG) in 20.4%, adequate in 37.1%, and excessive (eGWG) in 42.5% of the women. Predictors included general (height, prepregnancy body mass index category, and multiple pregnancy) and diabetes-related clinical characteristics. Neuropathy and follow-up length were associated with iGWG (odds ratio (OR) 3.00, 95% CI 1.22-7.37; OR 0.92, 95% CI 0.86-0.97, respectively), while pump use and third-trimester insulin dose were associated with eGWG (OR 1.68, 95% CI 1.07-2.66; OR 3.64, 95% CI 1.88-7.06, respectively). Independent predictors for corrected GWG and sensitivity analyses also included general and diabetes-related clinical characteristics. CONCLUSION: In this cohort of women with type 1 and type 2 diabetes, non-adequate GWG was common, mainly due to eGWG, and associated clinical characteristics were both general and diabetes-related. Current clinical care of these women during pregnancy may favor weight gain.

Association between inadequate weight gain according to the institute of medicine 2009 guidelines and pregnancy outcomes in women with thyroid disorders.

PURPOSE: Gestational weight gain (GWG) is an important contributor to pregnancy outcomes in the general obstetric population and different subgroups. The corresponding information in women with thyroid conditions is limited. We aimed to evaluate the relationship between GWG according to institute of medicine (IOM) and pregnancy outcomes in women with thyroid disorders. METHODS: We performed a retrospective analysis of 620 pregnant women either treated with levothyroxine (N = 545) or attended because of hyperthyroidism during pregnancy (N = 75). RESULTS: The associations between GWG according to IOM and pregnancy outcomes were present both in women treated with thyroid hormone and women followed by hyperthyroidism, most of them related to the fetal outcomes. In women treated with levothyroxine, insufficient GWG was associated with gestational diabetes mellitus (GDM) (odds ratio (OR) 2.32, 95% confidence interval (CI) 1.18, 4.54), preterm birth (OR 2.31, 95% CI 1.22, 4.36), small-for-gestational age newborns (OR 2.38, 95% CI 1.09, 5.22) and respiratory distress (OR 6.89, 95% CI 1.46, 32.52). Excessive GWG was associated with cesarean delivery (OR 1.66, 95% CI 1.10, 2.51) and macrosomia (OR 2.75, 95% CI 1.38, 5.49). Large-for-gestational age newborns were associated with both insufficient GWG (OR 0.25, 95% CI 0.11, 0.58) and excessive GWG (OR 1.80, 95% CI 1.11, 2.92). In women followed by hyperthyroidism, excessive GWG was associated with large-for-gestational age newborns (OR 5.56, 95% CI 1.03, 29.96). CONCLUSION: GWG according to IOM is associated with pregnancy outcomes both in women treated with thyroid hormone and women followed by hyperthyroidism.

Gestational weight gain and pregnancy outcomes in women with type 1 and type 2 diabetes mellitus.

AIMS: We aimed to explore the relationship between gestational weight gain (GWG) after Institute of Medicine (IOM) and pregnancy outcomes in women with type 1 and type 2 diabetes. METHODS: Retrospective cohort study at a tertiary medical center (1981-2011). OUTCOME VARIABLES: 2 maternal and 14 fetal. Main exposure variable: GWG according to IOM. We calculated crude and adjusted ORs as well as population attributable (PAF) and preventable fractions (PPF) for significant positive and negative associations, respectively. RESULTS: We evaluated 633 pregnant women with type 1 or type 2 diabetes. GWG was insufficient (iGWG) in 16.7% and excessive (eGWG) in 50.7%. In the adjusted analysis, GWG according to IOM was significantly associated with maternal outcomes (pregnancy-induced hypertension and cesarean delivery) and four fetal outcomes (large-for-gestational age, macrosomia, small-for-gestational age and neonatal respiratory distress). The association with large-for-gestational age newborns was negative for iGWG (0.48, CI 95% 0.25-0.94) and positive for eGWG (1.76, CI 95% 1.18-2.63). In addition, iGWG was associated with a higher risk of small-for-gestational age newborns and respiratory distress and eGWG with a higher risk of pregnancy-induced hypertension, caesarean delivery and macrosomia. PAF and PPF ranged from the 20.4% PPF of iGWG for large-for-gestational age to 56.5% PAF of eGWG for macrosomia. CONCLUSION: In this cohort of women with type 1 or type 2 diabetes, inadequate GWG after IOM was associated with adverse pregnancy outcomes; associations were unfavorable for eGWG and mixed for iGWG. The attributable fractions were not moderate, pointing to the potential impact of modifying inadequate GWG.

Impact of gestational diabetes mellitus treatment on medium/long-term outcomes after pregnancy: A systematic review and meta-analysis.

AIM: We aimed to evaluate the effect of gestational diabetes mellitus (GDM) treatment on medium/long-term outcomes both the mother and offspring. METHODS: We performed a systematic review on randomized clinical trials addressing specific treatment of women with GDM versus usual care and its impact on maternal and offspring outcomes at medium/long-term. MEDLINE, EMBASE and CENTRAL were searched from inception to 8 October 2021. OUTCOME VARIABLES: maternal (diabetes, metabolic syndrome, 12 secondary); offspring (diabetes, impaired fasting glucose, impaired glucose tolerance, high body mass index, 15 secondary). Risk of bias was assessed with Cochrane tool and aggregation performed with Revman 5.4. RESULTS: We included five studies (1140 women, 767 offspring) with follow-up ranging 4-16 years after delivery. GDM treatment likely does not reduce risk of maternal diabetes (RR 1.00; [95% CI 0.82-1.23]) and may not reduce that of metabolic syndrome (RR 0.93; [95% CI 0.71-1.22]). We obtained very uncertain evidence that treatment may increase maternal HDL-cholesterol. Findings showed that GDM treatment may not have an impact on infants' outcomes (RRs 0.79; [95% CI 0.39-1.69] for impaired fasting glucose; RR 0.91; [95% CI 0.74-1.12] for body mass index >85th centile and 0.89; [95% CI 0.65-1.22] for body mass index >95th centile respectively). CONCLUSIONS: With current evidence is uncertain if specific treatment of women with GDM has an impact on medium/long-term metabolic outcomes either in the mother or in the offspring. These results add evidence to the recommendation of systematically reevaluating mother and offspring after delivery. REGISTRATION: OSF, DOI 10.17605/OSF.IO/KFN79.

Hypopituitarism and pregnancy: clinical characteristics, management and pregnancy outcome.

PURPOSE: To describe the clinical characteristics, management and pregnancy outcome of women with prepregnancy hypopituitarism (HYPO) that received care at our center. METHODS: Retrospective study describing 12 pregnancies in women with prepregnancy HYPO (two or more pituitary hormonal deficiencies under replacement treatment) that received care during pregnancy at Hospital Santa Creu i Sant Pau. Clinical characteristics, management and pregnancy outcome were systematically collected. RESULTS: Average patients' age was 35 years and HYPO duration at the beginning of pregnancy was 19 years. The most frequent cause of HYPO was surgical treatment of a sellar mass (8 pregnancies). Eight pregnancies were in primigravid women and 10 required assisted reproductive techniques. The hormonal deficits before pregnancy were as follows: GH in 12 women, TSH in 10, gonadotropin in 9, ACTH in 5 and ADH in 2. All deficits were under hormonal substitution except for GH deficit in 4 pregnancies. During pregnancy, 4 new deficits were diagnosed. The dosage of replacement treatment for TSH, ACTH and ADH deficits was increased and GH was stopped. Average gestational age at birth was 40 weeks, gestational weight gain was excessive in 9 women, 8 patients required induction/elective delivery and cesarean section was performed in 6. Average birthweight was 3227 g. No major complications were observed. Five women were breastfeeding at discharge. CONCLUSIONS: In this group of women with long-standing HYPO, with careful clinical management (including treatment of new-onset hormonal deficits) pregnancy outcome was satisfactory but with a high rate of excessive gestational weight gain and cesarean section.

Inadequate Weight Gain According to the Institute of Medicine 2009 Guidelines in Women with Gestational Diabetes: Frequency, Clinical Predictors, and the Association with Pregnancy Outcomes.

BACKGROUND: In the care of women with gestational diabetes mellitus (GDM), more attention is put on glycemic control than in factors such as gestational weight gain (GWG). We aimed to evaluate the rate of inadequate GWG in women with GDM, its clinical predictors and the association with pregnancy outcomes. METHODS: Cohort retrospective analysis. OUTCOME VARIABLES: GWG according to Institute of Medicine 2009 and 18 pregnancy outcomes. Clinical characteristics were considered both as GWG predictors and as covariates in outcome prediction. STATISTICS: descriptive, multinomial and logistic regression. RESULTS: We assessed 2842 women diagnosed with GDM in the 1985-2011 period. GWG was insufficient (iGWG) in 50.3%, adequate in 31.6% and excessive (eGWG) in 18.1%; length of follow-up for GDM was positively associated with iGWG. Overall pregnancy outcomes were satisfactory. GWG was associated with pregnancy-induced hypertension, preeclampsia, cesarean delivery and birthweight-related outcomes. Essentially, the direction of the association was towards a higher risk with eGWG and lower risk with iGWG (i.e., with Cesarean delivery and excessive growth). CONCLUSIONS: In this cohort of women with GDM, inadequate GWG was very common at the expense of iGWG. The associations with pregnancy outcomes were mainly towards a higher risk with eGWG and lower risk with iGWG.

Both glycaemic control and insulin dose during pregnancy in women with type 1 diabetes are associated with neonatal anthropometric measures and placental weight.

BACKGROUND: To investigate longitudinal associations of maternal glucose/HbA1c and insulin dose with birthweight-related outcomes in women with type 1 diabetes. METHODS: We performed a cohort study including 473 pregnant women with type 1 diabetes with singleton pregnancies. We investigated maternal self-monitored blood glucose (SMBG, mmol/L), HbA1c (%, mmol/mol) and insulin dose (IU/kg/day) in the three trimesters as potential independent variables, while adjusting for potential confounders. Outcomes of interest were birthweight, birthweight SD score, neonatal length, weight/length index, ponderal index and placental weight. Multiple linear regression analysis was performed with separate analyses for SMBG and HbA1c . RESULTS: Maternal glucose and insulin dose were independently associated with birthweight-related outcomes. In the main analysis, in the first trimester most associations were positive for insulin dose, in the second the associations were positive for glucose and inverse for insulin while in the third there were no associations. Most sensitivity analyses produced consistent results. In a sensitivity analysis splitting the first trimester in two periods, positive associations of maternal insulin with birthweight-related outcomes were observed in weeks 0+ to 6+. CONCLUSIONS: Early in pregnancy in women with type 1 diabetes, maternal insulin dose is positively associated with birthweight-related outcomes, whereas in the second trimester, a positive association with SMBG emerges and the association with maternal insulin becomes inverse. If confirmed in other cohorts, these results would have implications in the management of women with type 1 diabetes.

Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight.

OBJECTIVE: Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS: Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS: From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (-4.07 mg/dL [95% CI -7.58, -0.57]; P = 0.02 and -7.78 mg/dL [95% CI -12.27, -3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (-170.62 g [95% CI -333.64, -7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS: Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.

Pharmacotherapy for hyperglycemia in pregnancy - Do oral agents have a place?

Diabetes is a frequent condition in pregnancy and achieving adequate glycemic control is of paramount importance. Insulin treatment is the gold standard, oral agents are more attractive, but their safety and efficiency should be a prerequisite for their use. We have more information regarding treatment of women with gestational diabetes mellitus where glyburide can induce a picture of fetal hyperinsulinism (higher birthweight and more neonatal hypoglycemia) whereas metformin requires supplemental insulin in a larger proportion of women but achieves satisfactory perinatal outcomes with the exception of preterm birth. Information in patients with Type 2 Diabetes Mellitus is much more limited but also favors metformin. Combinations provide additional possibilities. However, as to long-term outcomes, we have no information on the impact of exposure to glyburide and it is still unclear if in utero exposure to metformin will have any effect on the offspring and the direction of this effect. Women prefer oral agents, indicating the need of additional studies.

Antenatal oral glucose tolerance test in women with gestational diabetes mellitus: fasting plasma glucose is the best predictor of both large for-gestational-age newborns and postpartum glucose tolerance.

BACKGROUND: Numerous studies have evaluated the predictors of large-for-gestational-age newborns (LGA) as well as abnormal glucose tolerance (AGT) after delivery in women with gestational diabetes mellitus, one at a time. The present study assesses the ability of glucose values on the antenatal oral glucose tolerance test (OGTT) to predict both outcomes. METHODS: Retrospective analysis of a prospectively collected database. Gestational diabetes was diagnosed with a two-step approach. After delivery, reevaluation was performed using 2006 WHO definition of glucose tolerance. SELECTION CRITERIA: 1) singleton pregnancies; 2) available information on: offspring weight for age, antenatal and follow-up OGTT and additional potential predictors of LGA and AGT. The study included 1241 women. Data were analyzed by multivariate logistic regression and ROC analyses. Logistic regression models were used to calculate adjusted and unadjusted odds ratios and corresponding 95% CI for 1 mmol/L increase in each glucose value (FPG, 1 h, 2 h, 3 h) of the diagnostic 100-g OGTT, associated to the main outcomes LGA and postpartum AGT. RESULTS: Analyzing each glucose value on antenatal OGTT, fasting plasma glucose (FPG) showed the highest OR for both outcomes: LGA (1.537, 95% CI 1.237-1.910) and AGT (2.288, 95% CI 1.869-2.801). On the adjusted analysis the association was attenuated, but FPG continued to be the best predictor for both outcomes. CONCLUSIONS: In women with gestational diabetes mellitus, FPG on the diagnostic OGTT was the glycemic value that best predicted both LGA and after delivery AGT.

Systematic review and meta-analysis on the association of prepregnancy underweight and miscarriage.

BACKGROUND: Maternal underweight, overweight and obesity have been associated with a higher risk of miscarriage. Most individual reports and all meta-analyses have addressed high body mass index. OBJECTIVES: To review the literature and summarize the risk of miscarriage in underweight women vs those with normal weight. METHODS: A Medline Search (1st January 1990-20th November 2015, human, in English, French, Italian, Spanish or Portuguese) was conducted. Both spontaneous pregnancies and pregnancies after assisted reproduction techniques were considered. Cohort and case control studies were included if they reported data on the outcome of interest (clinical miscarriage), in underweight and normal weight women. Information on clinical miscarriage in other body mass index categories was collected when available. Two investigators reviewed the abstracts, full text papers and extracted data. Review Manager 5.1 software was used to summarize the results. RESULTS: 32 studies (30 cohort, 2 case control) and a total of 265,760 women were included. In cohort studies, the relative risk (RR) of clinical miscarriage in underweight women was 1.08, 95% CI 1.05-1.11; p<0.0001). The corresponding figures were RR 1.09, 95% CI 1.04-1.13; p<0.0001 for overweight women and RR 1.21, 95% CI 1.15-1.27; p<0.00001 for obese women. In case control studies, the odds ratio (OR) of clinical miscarriage in underweight women was 1.02, 95% CI 0.46-2.30; p=0.95). The corresponding figures were OR 1.01, 95% CI 0.88-1.16; p=0.89 for overweight women and OR 1.26, 95% CI 1.01-1.57; p=0.04 for obese women. The limitations of this study are that it is restricted to studies with information on underweight women and that I2 ranges from 0 to 91% in different subgroups. CONCLUSION: We conclude that maternal underweight is associated with a slightly increased risk of clinical miscarriage, similar to that of overweight women and lower than the risk observed in obesity. The heterogeneity displayed in some subgroups limits the strength of the conclusion.

Sex ratio at birth is associated with type 1 diabetes characteristics.

AIMS: To assess the association between maternal diabetes characteristics and sex ratio at birth (SRB) in women with type 1 diabetes mellitus. METHODS: We performed a case-control study. The study subjects were infants born alive to women with type 1 diabetes and singleton pregnancies. Cases and controls were defined as male and female newborns, respectively. SRB was analysed according to diabetes-related characteristics adjusting in a logistic regression analysis for maternal characteristics known to affect SRB in the general population. RESULTS: The observed SRB (238 males/468 live births = 0.509) did not differ from the expected. In the logistic regression analysis, SRB was significantly associated with three diabetes characteristics: (1) diabetes duration, with odds ratios (ORs) for a live male newborn = 1.22 (95 % confidence interval (CI), 0.66-2.24 for ≤5 years, OR 2.79 (95 % CI 1.36-5.74) for >20 years; (2) mean first-trimester glycated haemoglobin, with OR 1.98 (95 % CI 1.09-3.62) for ≤6.7 % (50 mmol/mol) and OR 2.61 (95 % CI 1.16-5.85) for >8.2 % (66 mmol/mol) and (3) mean first-trimester insulin dose, with OR 0.70 (95 % CI 0.36-1.38) for ≤0.5 IU/kg/day and OR 0.18 (95 % CI 0.05-0.59) for >1.0 IU/kg/day. CONCLUSIONS: We conclude that SRB in this cohort is independently associated with three diabetes characteristics. These associations are to be confirmed.

Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis.

OBJECTIVE: To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational diabetes requiring drug treatment. DESIGN: Systematic review and meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized controlled trials that fulfilled all the following: (1) published as full text; (2) addressed women with gestational diabetes requiring drug treatment; (3) compared glibenclamide v insulin, metformin v insulin, or metformin v glibenclamide; and (4) provided information on maternal or fetal outcomes. DATA SOURCES: Medline, CENTRAL, and Embase were searched up to 20 May 2014. OUTCOMES MEASURES: We considered 14 primary outcomes (6 maternal, 8 fetal) and 16 secondary (5 maternal, 11 fetal) outcomes. RESULTS: We analyzed 15 articles, including 2509 subjects. Significant differences for primary outcomes in glibenclamide v insulin were obtained in birth weight (mean difference 109 g (95% confidence interval 35.9 to 181)), macrosomia (risk ratio 2.62 (1.35 to 5.08)), and neonatal hypoglycaemia (risk ratio 2.04 (1.30 to 3.20)). In metformin v insulin, significance was reached for maternal weight gain (mean difference -1.14 kg (-2.22 to -0.06)), gestational age at delivery (mean difference -0.16 weeks (-0.30 to -0.02)), and preterm birth (risk ratio 1.50 (1.04 to 2.16)), with a trend for neonatal hypoglycaemia (risk ratio 0.78 (0.60 to 1.01)). In metformin v glibenclamide, significance was reached for maternal weight gain (mean difference -2.06 kg (-3.98 to -0.14)), birth weight (mean difference -209 g (-314 to -104)), macrosomia (risk ratio 0.33 (0.13 to 0.81)), and large for gestational age newborn (risk ratio 0.44 (0.21 to 0.92)). Four secondary outcomes were better for metformin in metformin v insulin, and one was worse for metformin in metformin v glibenclamide. Treatment failure was higher with metformin than with glibenclamide. CONCLUSIONS: At short term, in women with gestational diabetes requiring drug treatment, glibenclamide is clearly inferior to both insulin and metformin, while metformin (plus insulin when required) performs slightly better than insulin. According to these results, glibenclamide should not be used for the treatment of women with gestational diabetes if insulin or metformin is available.Systematic review registration NCT01998113.

Ultrasound-guided compared to conventional treatment in gestational diabetes leads to improved birthweight but more insulin treatment: systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis of randomized controlled trials assessing ultrasound-guided versus conventional management in women with a broad severity-spectrum of gestational diabetes mellitus. DESIGN: Systematic review and meta-analysis of trials published until August 2012. SETTING: PubMed and Web of Science databases. STUDY SELECTION AND METHODS: Eighteen studies were reviewed in full text. Eligibility criteria were (i) randomized controlled trials comparing metabolic management in women with gestational diabetes mellitus and ultrasound-based vs. the conventional management to assess fetal growth, (ii) representative of the whole spectrum of hyperglycemia and fetal growth, (iii) data on perinatal outcomes. Review Manager 5.0 was used to summarize the results. RESULTS: Two studies fulfilled inclusion criteria. The ultrasound-guided group had a lower rate of large-for-gestational age newborns (relative risk 0.58, 95% confidence interval 0.34-0.99), macrosomia (relative risk 0.32, 95% confidence interval 0.11-0.95) and abnormal birthweight (small/large-for-gestational age, relative risk 0.64, 95% confidence interval 0.45-0.93) and a higher rate of insulin treatment (relative risk 1.58, 95% confidence interval 1.14-2.20). The number of women with gestational diabetes with a need to treat to prevent an additional newborn with abnormal birthweight was 10. CONCLUSIONS: In women with a broad severity-spectrum of gestational diabetes mellitus, ultrasound-guided management improves birthweight distribution, but increases the need for insulin treatment. More research is needed in this area because results are derived from a limited number of patients.

[Gestational diabetes mellitus and maternal ethnicity: high prevalence of fetal macrosomia in non-Caucasian women]. / Diabetes mellitus gestacional y etnia materna: alta prevalencia de macrosomía fetal en mujeres no caucásicas.

BACKGROUND AND OBJECTIVE: Differences in perinatal outcomes according to ethnicity have been described in pregnant women with gestational diabetes mellitus (GDM). We analysed the relationship between ethnicity, maternal characteristics and perinatal outcomes in pregnant women with GDM. PATIENTS AND METHODS: Retrospective analysis of women with GDM attended at the centre between 1986 and 2007. We studied 2,543 mother-infant pairs (8.9% multiple pregnancies, 2,480 Caucasian [C] and 63 non-Caucasian [NC] mothers). Maternal characteristics and perinatal outcomes were compared according to maternal ethnicity and multivariable logistic regression analyses (backward method) were performed to predict perinatal outcomes. RESULTS: The groups (C vs NC) differed in previous pregnancies, obstetric history, pregestational body mass index, delay between diagnosis and clinic entry, fasting plasma glucose at diagnosis and both initial and third trimester glycated hemoglobin, with all of them being worse in NC group. As to perinatal outcomes, we also observed differences in the prevalence of macrosomic (4.3 vs 19.4%) and large for gestational age newborns (LGA) (9.5 vs 32.3%), all of them being higher in the NC group. In the logistic regression analyses, NC was an independent predictor of macrosomia, LGA and jaundice with odds ratio ranging from 2.767 (95% confidence interval [95% CI] 1.257-6.091) for LGA and 3.629 (95% CI 0.972-13.548) for neonatal jaundice. CONCLUSIONS: NC-GDM patients had more adverse perinatal outcomes only partially explained by medical history, anthropometric data and maternal glycemic control. NC ethnicity was an independent predictor of poor perinatal outcomes.

Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex.

BACKGROUND: Male sex is a well-known risk factor for unfavorable perinatal outcomes. Fetal sex has been considered only occasionally in diabetic pregnancy. OBJECTIVE: Our aim was to evaluate perinatal outcomes in women with gestational diabetes mellitus (GDM) according to fetal sex. METHODS: We conducted a retrospective review of all singleton pregnancies of women with GDM progressing to >22 weeks and delivering in our center between 1981 and 2007. Evaluated maternal characteristics included anthropometrics, obstetric history, GDM diagnosis characteristics (ie, gestational age, blood glucose values), HbA(1c) (after diagnosis and in the third trimester). Outcomes variables were cesarean section (CS), gestational hypertension, preterm birth, abnormal Apgar, large and small for gestational age newborns, obstetric trauma, major and minor malformations, neonatal hypoglycemia, jaundice, respiratory distress, polycythemia, hypocalcemia, perinatal mortality, and a composite outcome. We used a descriptive and multiple logistic regression analysis (backwards method). RESULTS: A total of 2299 pregnancies were included (1125 female and 1174 male infants). Maternal characteristics were essentially similar in male and female newborns. For outcomes, unadjusted figures were higher in pregnancies of male newborns in 14 of 16 perinatal outcomes, but significance was only reached for CS. The logistic regression analyses revealed male sex as an independent predictor of CS (odds ratio = 1.48; 95% CI, 1.15-1.90) and neonatal hypoglycemia (odds ratio = 2.13; 95% CI, 1.02-4.43). CONCLUSIONS: In this group of women with GDM, perinatal outcomes in pregnancies of male newborns differ in only 2 of 16 evaluated variables: an increased frequency of CS and neonatal hypoglycemia. Male newborns of mothers with GDM could benefit from increased awareness of neonatal hypoglycemia.

Maternal body mass index is a predictor of neonatal hypoglycemia in gestational diabetes mellitus.

CONTEXT: In diabetic pregnancy, neonatal hypoglycemia (NH) is usually attributed to insufficient regulation of maternal glycemic control. Recent data suggest that maternal body mass index (BMI) could have an influence. OBJECTIVE: Our objective was to determine whether an association exists between maternal prepregnancy BMI category and occurrence of NH among infants born to women with gestational diabetes mellitus (GDM). DESIGN AND SETTING: This was a retrospective study including all GDM pregnancies delivered between 1986 and 2006 at a tertiary care center (Hospital de la Santa Creu i Sant Pau, Barcelona). PATIENTS AND OUTCOMES: GDM was diagnosed using universal screening and National Diabetes Data Group criteria. Two thousand ninety-two newborns (1925 singletons, 85% of total GDM offspring) were studied. NH was defined according to Cornblath criteria. In addition to maternal BMI, we considered other variables such as glucose values at diagnosis or third-trimester glycated hemoglobin as potential predictors of NH. We explored whether the association between maternal BMI and NH could be due to intermediate steps such as cesarean section or abnormal birth weight. RESULTS: The rate of NH was 3%. In the bivariate analysis, prepregnancy BMI was higher in the NH group (24.45 vs. 23.19 kg/m(2), P < 0.02). In the logistic regression analysis, prepregnancy BMI of at least 25 kg/m(2) was independently associated with NH whether the analysis included intermediate variables (odds ratio = 2.11; 95% confidence interval = 1.10-4.03) or not (odds ratio = 2.66; 95% confidence interval = 1.44-4.92). CONCLUSIONS: Pregestational BMI should be considered among the predictors of NH in offspring of women with GDM.