Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study.

BACKGROUND: To evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery. METHODS: An analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%. RESULTS: The mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90-94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges. CONCLUSION: Second and third trimester fasting glucose levels below the cut-off values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.

Sobrepeso e obesidade pré-gestacionais: prevalência e desfechos associados à gestação / Pregestational overweight and obesity: prevalence and outcome associated with pregnancy

OBJETIVO: Descrever o resultado obstétrico de mulheres com sobrepeso/obesidade atendidas no serviço de pré-natal de uma maternidade pública no Rio de Janeiro. MÉTODOS: Estudo do tipo descritivo transversal, tendo sido incluídas 433 puérperas (³20 anos, sem enfermidades crônicas) e seus respectivos recém-nascidos atendidos em maternidade pública do Rio de Janeiro. As informações foram coletadas em prontuários e por meio de entrevistas. As características maternas e dos recém-nascidos avaliadas foram agrupadas em maternas (hábitos sociais, antropométricas, da assistência pré-natal, clínicas e obstétricas) e dos recém-nascidos (condições ao nascer). A avaliação da razão de chance entre as categorias de estado nutricional os desfechos gestacionais se deu por meio da odds ratio (OR), com intervalos de confiança (IC) de 95 por cento. RESULTADOS: A prevalência de sobrepeso/obesidade nesta casuística foi de 24,5 por cento (n=106). Observou-se uma associação entre ganho de peso inadequado e a frequência de sobrepeso/obesidade (OR 2,7; IC95 por cento 1,5-4,9; p<0,05). As mulheres com sobrepeso/obesidade apresentaram maior risco para pré-eclâmpsia (OR 3,3; IC95 por cento 1,1-9,9; p=0,03). Quanto às condições ao nascimento, verificou-se peso médio ao nascer de 3291,3 g (±455,2), sendo as taxas de baixo peso de 4,7 por cento (n=5) e macrossomia de 2,8 por cento (n=3). CONCLUSÕES: Observou-se uma prevalência alarmante de inadequação do estado nutricional pré e gestacional, que pode associar-se ao maior risco de morbimortalidade perinatal. Com isso, sugere-se a necessidade de monitoramento nutricional dessas gestantes.

PURPOSE: To describe the obstetric outcome of women with overweight/obesity treated at the prenatal care clinic of a public maternity hospital in Rio de Janeiro. METHODS: A descriptive cross-sectional study which investigated 433 women (³20 years-old, without any chronic diseases) and their newborns treated at public hospitals in Rio de Janeiro. Information was collected from medical records and through interviews. The characteristics of mothers and newborns evaluated were divided into maternal (social habits, anthropometric measurements and clinical, obstetric, and prenatal care) and newborn groups (birth conditions). Data regarding the categories of nutritional status were analyzed using the odds ratio (OR) and 95 percent confidence interval (CI). RESULTS: The prevalence of overweight/obesity in this sample was 24.5 percent (n=106). There was an association between inadequate weight gain and the prevalence of overweight/obesity (OR 2.7, 95 percentCI 1.5-4.9, p<0.05). Overweight/obese women had an increased risk for preeclampsia (OR 3.3, 95 percentCI 1.1--9.9, p=0.03). Regarding birth conditions, mean birth weight was 3291.3 g (±455.2), with rates of low birth weight of 4.7 percent (n=5) and rates of macrosomia of 2.8 percent (n=3). CONCLUSIONS: There was an alarming prevalence of inadequate nutritional status before and during pregnancy, which may be associated with increased risk of perinatal morbidity and mortality. This suggests the need for nutritional monitoring of these pregnant women.

[Pregestational overweight and obesity: prevalence and outcome associated with pregnancy]. / Sobrepeso e obesidade pré-gestacionais: prevalência e desfechos associados à gestação.

PURPOSE: To describe the obstetric outcome of women with overweight/obesity treated at the prenatal care clinic of a public maternity hospital in Rio de Janeiro. METHODS: A descriptive cross-sectional study which investigated 433 women (≥20 years-old, without any chronic diseases) and their newborns treated at public hospitals in Rio de Janeiro. Information was collected from medical records and through interviews. The characteristics of mothers and newborns evaluated were divided into maternal (social habits, anthropometric measurements and clinical, obstetric, and prenatal care) and newborn groups (birth conditions). Data regarding the categories of nutritional status were analyzed using the odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence of overweight/obesity in this sample was 24.5% (n=106). There was an association between inadequate weight gain and the prevalence of overweight/obesity (OR 2.7, 95%CI 1.5-4.9, p<0.05). Overweight/obese women had an increased risk for preeclampsia (OR 3.3, 95%CI 1.1--9.9, p=0.03). Regarding birth conditions, mean birth weight was 3291.3 g (±455.2), with rates of low birth weight of 4.7% (n=5) and rates of macrosomia of 2.8% (n=3). CONCLUSIONS: There was an alarming prevalence of inadequate nutritional status before and during pregnancy, which may be associated with increased risk of perinatal morbidity and mortality. This suggests the need for nutritional monitoring of these pregnant women.