Profile of Pregnant Women with Gestational Diabetes Mellitus at Increased Risk for Large for Gestational Age Newborns.

ABSTRACT

OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with a higher risk of perinatal morbidity and mortality, and its main complication is the occurrence of large for gestational age (LGA) newborns. The present study aims to characterize pregnant women with GDM and to identify factors associated with the occurrence of LGA newborns in this population. METHODS: A cross-sectional study was performed based on medical records of women whose prenatal care and delivery were performed at the Maternal and Child Unit of the Hospital Universitário of the Universidade Federal do Maranhão, state of Maranhão, Brazil. A total of 116 pregnant women diagnosed with GDM were included according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). RESULTS: The variables associated with LGA newborns after multivariate analysis were obesity prior to pregnancy (OR = 11.6; 95% CI 1.40-95.9), previous macrosomia (OR = 34.7; 95% CI 4.08-295.3), high blood glucose levels in the 3rd trimester (OR = 2,67; 95% CI 1.01-7.12) and combined change in the oral glucose tolerance test (OGTT) (fasting + postdextrose) (OR = 3.53; 95% CI 1.25-14.2) = 1.17-10.6). Otherwise, insufficient weight gain during pregnancy reduced the risk for LGA newborns (OR = 0.04; 95% CI 0.01-0.32). CONCLUSION: Obesity prior to pregnancy, previous macrosomia, high blood glucose levels in the 3rd trimester, and combined change in the OGTT were independent predictive factors for LGA newborns in pregnant women with GDM.

RESUMO

OBJETIVO: Diabetes mellitus gestacional (DMG) está associado a um maior risco de morbidade e mortalidade perinatais, e sua principal complicação é a ocorrência de recém-nascidos grandes para idade gestacional (GIG). O presente estudo visa caracterizar as gestantes com DMG e identificar fatores associados à ocorrência de recém-nascidos GIG nesta população. MéTODOS: Estudo transversal realizado a partir da coleta de dados de prontuário de mulheres cujo acompanhamento pré-natal e parto foram realizados na Unidade Materno-Infantil do Hospital Universitário da Universidade Federal do Maranhão, MA, Brasil. Foram incluídas 116 gestantes diagnosticadas com DMG pelo critério do International Association of Diabetes and Pregnancy Study Groups (IADPSG). RESULTADOS: As variáveis associadas à GIG após análise multivariada foram obesidade pré-gestacional (OR= 11,6; IC 95% 1,40­95,9), macrossomia anterior (OR = 34,7; IC 95% 4,08­295,3), glicemia em jejum elevada no 3° trimestre (OR = 2,67; IC 95% 1,01­7,12) e alteração combinada no teste de tolerância oral à glicose (jejum + pós-dextrose) (OR= 3,53; IC 95% 1,17­10,6). Ganho de peso inferior reduziu o risco para GIG (OR= 0,04; IC 95% 0,01­0,32). CONCLUSãO: Obesidade anterior à gestação, macrossomia prévia, níveis elevados de glicose no sangue no 3° trimestre e alteração combinada no TOTG foram fatores preditivos independentes para os recém-nascidos GIG em gestantes com DMG.