Introduction: GDM prevalence is increasing worldwide. The aim of the study was to identify potentially modifiable predictors of adverse neonatal outcomes in women with GDM.
Methods: This prospective observational study included 576 singleton multiethnic women diagnosed with GDM after 13 weeks of gestational age, followed in the Diabetes and Pregnancy Unit of the CHUV between 4/2012 and 2/2017. Predictors included HbA1c at booking after GDM diagnosis and at the end of the pregnancy, treatment requirement (treatment vs no treatment), excessive gestational weight gain (GWG) according to the Institute of Medicine guidelines and BMI at booking after GDM diagnosis. Neonatal and maternal outcomes included macrosomia (birth weight (BW)>4 kg), LGA (BW-centile≥90), SGA (BW-centile ≤10), hypoglycemia (glycemia <2.5 mmol/l), prematurity (gestational age<37 weeks), hospitalisation in a neonatal care unit, respiratory distress requiring ICU admission, and need for cesarian section. Data were analysed using logistic regression analysis, adjusting for sex and gestational age at birth.
Results: Mean HbA1c was 5.5±0.4% at booking after GDM diagnosis, and 5.6±0.4% at the end of the pregnancy; 42% of women did not require treatment. Mean BMI at booking after GDM diagnosis was 30±5.5 kg/m2 and gestational weight gain 12.6±7.2 kg, with 41% of women having excessive GWG. The mean gestational age at birth was 38.9±2 weeks and mean birth weight was 3242±587 g. 7.6% had macrosomia, 17% were LGA, and 9.4% SGA. 11% had hypoglycemia, 8.2% were premature, 12% were transferred to a neonatal care unit, and 5% had respiratory distress requiring ICU admission. Cesarian delivery rate was 38%. HbA1c at booking after GDM diagnosis and at the end of pregnancy predicted macrosomia and LGA. HbA1c at booking after GDM diagnosis was also correlated with cesarean section requirement, and at the end of pregnancy with prematurity. Treatment requirement predicted macrosomia, LGA, hypoglycemia and cesarean section requirement. BMI at booking was correlated with macrosomia and LGA, and inversely correlated with SGA. Excessive GWG predicted macrosomia.
Conclusion: HbA1c at booking after GDM diagnosis and at the end of pregnancy constitutes a simple marker which can help clinicians in the management of women with GDM, but is currently not systematically used. Weight gain in pregnant women should be carefully monitored. Precise universal guidelines for maternal and neonatal follow-up and interventions (cesarean section, timing of delivery, neonatal glucose monitoring) depending on clinical predictors including treatment modality, excessive GWG, and HbA1c levels, are needed.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology