Perinatal outcomes associated with the diagnosis of gestational diabetes: Systematic review and meta-analysis.

OBJECTIVE: To compare perinatal outcomes in pregnant women diagnosed with gestational diabetes using the one-step and the two-step test. METHODS: Meta-analysis of observational studies pregnancies women with gestational diabetes from January 2014 to February 2019. The outcomes studied were induction of labor and delivery, preterm delivery, fetal macrosomia, neonatal hypoglycemia, hyperbilirubinemia, low birth weight, and admission to the neonatal intensive care unit. RESULTS: Eight studies were included with a population of 108,609 pregnancies. Statistical differences were obtained for fetal macrosomia RR0.9 (95%CI0.85-0.97; I20%) and neonatal hypoglycemia RR1.1 (95%CI1.01-1.40; I248.5%). CONCLUSION: Neonatal macrosomia appears to be less present when the one-step diagnostic test is used and neonatal hypoglycemia was lower with the two-step test. Register PROSPERO CRD42020215062.

The triad macrosomia, obesity, and hypertriglyceridemia in gestational diabetes.

AIMS: Offspring of women with gestational diabetes (GD) have more macrosomia than newborns of normal mothers. We studied macrosomia frequency, possible pathogenesis, and main predictors of its appearance at different gestational ages. MATERIALS AND METHODS: A total of 1870 pregnant women with GD were recruited in primary care centres and maternity hospitals in the Argentine provinces of Corrientes, Chaco, Buenos Aires, and in Buenos Aires City; 1088 completed gestation and delivered an infant. We collected clinical and metabolic data, personal and obstetric history, and gestational and delivery characteristics. Presence of macrosomia was analysed in the whole population, the entire pregnancy, and in each trimester of gestation. Data were statistically analysed and values were expressed as mean ± SD and percentages. The study protocol was approved by the Ethics Committee and all participants signed informed consent. RESULTS: Macrosomia was found in 12.9% of newborns and obesity in all mothers with no significant differences between mothers with/without macrosomic offspring. In early pregnancy, the main significant indicators of macrosomia were: history of dyslipidaemia (5.6% vs 1.2%, respectively) and macrosomia in previous pregnancies (27% vs 13%, respectively). However, the third trimester showed a significant combination of higher BMI, FBG, and triglycerides. CONCLUSIONS: Offspring of women with GD presented macrosomia in 12.9% of cases, maternal history of dyslipidaemia and macrosomia in previous pregnancies being early predictors. The combination of maternal obesity, FBG, and hypertriglyceridemia became significant during the last trimester of pregnancy.

Características de neonatos macrosomicos y de sus madres, del hospital herminda martin de chillan / Characteristics of mothers and their macrosomic newborns of herminda martin hospital of chillan

Newborn macrosomy is a condition appearing with increasing frequency reaching 9,46 percent in Chile in 2003. This alteration increases maternal and fetal morbi-mortality. The purpose of this study was to recognize the characteristics of mothers and their macrosomic newborns at birth in a Hospital of Chillán. A descriptive study of 302 macrosomic newborns and their mothers was done. The data was obtained from the Perinatal Information System and maternal clinical files. These newborns were mainly males, length and head circumference large for gestational age, normal ponderal index, and did not present any pathology. The mothers were mainly characterized as being between 18 to 35 years of age, without pathologies but presenting malnutrition for excess before and at the term of pregnancy, and a weight increase during pregnancy higher than recommended. It is suggested that the nutritional situation of the women be optimized in Chile before and during pregnancy.

La macrosomía neonatal es una condición cuya frecuencia ha ido en aumento, llegando en Chile a un 9,46 por ciento el año 2 003, esta alteración aumenta la morbimortalidad materno- fetal. El propósito de este estudio fue conocer las características de los neonatos macrosómicos y de sus madres, atendidos en el Hospital Herminda Martín de Chillán. Se realizó un estudio descriptivo a 302 neonatos macrosómicos y sus madres. Los datos se obtuvieron del Sistema Informático Perinatal y de las historias clínicas maternas. Los neonatos se caracterizaron principalmente por tener género masculino, talla y perímetro cefálico grande para la edad gestacional, índice ponderal normal y no presentar patología. Las madres se caracterizaron principalmente por tener entre 18 y 35 años, no tener patologías, presentar malnutrición por exceso previo y al finalizar el embarazo y aumentar de peso más de lo recomendado. Se sugiere optimizar el estado nutricional previo y durante al embarazo de las madres.

Estimation of gestational age by the length of the dorsal spine.

Gestational age assessed by dorsal spine length (DSL) was compared with that based on date of the last menstrual period (LMP). This study was performed in 70 newborn infants admitted to a neonatal intensive care unit requiring chest radiography, by which dorsal spine length was measured (figure 1). Gestational age ranged from 23 to 42 weeks. Regression analysis were performed on DSL and gestational age. Estimation error was evaluated based on the percentage of agreement in weeks (validity) and the difference in averages between both methods (accuracy) (table I and figure 2). Variations during the first week of life were also studied and no significant differences were found. For infants born at 31 weeks or less, DSL overestimated gestational age in one week. There was no differences between 32 and 36 weeks, and over 37 weeks, underestimation was one week (figure 3). With this correction a table was built estimating gestational age for different DSL; percentage of agreement was 91.4% for +/- 3 weeks (table III). This methodology assists the clinician to evaluate gestational age by an objective method, that does not vary during the first week of life and that can be obtained retrospectively.