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Monteiro SS, Santos TS, Fonseca L, Saraiva M, Pereira T, Vilaverde J, Pichel F, Pinto C, Almeida MC, Dores J. Maternofetal outcomes in early-onset gestational diabetes: does weight gain matter? J Endocrinol Invest 2022; 45:2257-2264. [PMID: 35821458 DOI: 10.1007/s40618-022-01855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
AIM Women with early-onset gestational diabetes mellitus (GDM) have overall lower gestational weight gain (GWG) compared to those with later-onset GDM, albeit with usually worse maternofetal outcomes. We intent to investigate the association between inadequate GWG and maternofetal outcomes in pregnant women with early-onset GDM. METHODS We performed a retrospective study of women with early-onset GDM based on the National Registry of GDM. Three study groups were defined according to the recommendations of the Institute of Medicine for GWG: excessive GWG (eGWG), adequate (aGWG) or insufficient (iGWG). RESULTS A total of 8040 pregnant women were included: 27% (n = 2170) eGWG, 31% (n = 2492) aGWG and 42% (n = 3378) iGWG. Preeclampsia (4.3 vs 3 vs 1.6%, p < 0.001), polyhydramnios (3.1 vs 2.3 vs 1.8%, p = 0.008) and cesarean section (37.4 vs 34.1 vs 29.5%, p < 0.001) were significantly more frequent among women with eGWG. Additionally, there was a higher frequency of macrosomia (8.1 vs 3.6 vs 2.4%, p < 0.001), large-for-gestational-age (8.2 vs 3.7 vs 2.6%, p < 0.001) and birth trauma (2.6 vs 1.5 vs 1.1%, p < 0.001) in this group. On the other hand, fetal death (0.2 vs 0.2 vs 0.5%, p = 0.04), small-for-gestational-age (9 vs 10.3 vs 14.9, p < 0.001) and preterm delivery (5.6 vs 7.1 vs 7.5%, p = 0.03) were more frequent in iGWG group. CONCLUSIONS Over two-thirds of pregnant women with early-onset GDM had inappropriate GWG, which was significantly associated with adverse maternofetal outcomes. Weight management must be a focus of special attention in women with early-onset GDM, beyond glycemic control, to achieve healthy pregnancy outcomes.
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Affiliation(s)
- S S Monteiro
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - T S Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L Fonseca
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - M Saraiva
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - T Pereira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Vilaverde
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - F Pichel
- Division of Nutrition, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Pinto
- Division of Obstetrics, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - M C Almeida
- On Behalf of the Pregnancy and Diabetes Study Group of the Portuguese Diabetes Society, Maternidade Bissaya Barreto, Coimbra, Portugal
| | - J Dores
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
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Saraiva M, Fonseca L, Santos T, Vilaverde J, Pereira MT, Pichel F, Pinto C, Almeida MC, Dores J. Mild periconceptional hyperglycemia: predictor of adverse fetomaternal outcomes in gestational diabetes? Acta Diabetol 2021; 58:1209-1215. [PMID: 33856590 DOI: 10.1007/s00592-021-01714-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
AIM To clarify whether mild first trimester hyperglycaemia (characteristic of early-onset GDM) is associated with higher incidence of congenital malformations and other adverse fetomaternal outcomes compared to women with second trimester hyperglycaemia (later-onset GDM). DESIGN AND METHODS We analyzed the Portuguese National GDM database, containing data collected between 2011 and 2017. Two study groups were defined: Group 1-Women with GDM diagnosed during the first trimester (with fasting glycemia ≥ 92 and < 126 mg/dL); Group 2-Women with GDM diagnosed after the first 12 weeks of gestation, with either fasting glycemia or oral glucose tolerance test, according to the International Association of Pregnancy and Diabetes Study Group criteria. The fetomaternal characteristics of each group were compared. RESULTS A total of 18.518 pregnant women diagnosed with GDM were included which 34.4% of them belonged to Group 1. Pregnant women from this group were significantly younger and had a higher median BMI than the women from the other group. Overall, there was no significant differences in maternal morbidity parameters between groups. Non-evolutive pregnancies were significantly more frequent along the present gestation in the group 1 (1.1% vs. 0.1%, p < 0.001), as was fetal death (0.6% vs. 0.2%, p < 0.001). Congenital malformations did not differ significantly between groups (3.2% vs. 2.8%, p = 0.155). CONCLUSIONS The mild near conceptional hyperglycaemic state characteristic of an early-onset GDM seems to be associated with an increased prevalence of non-evolutive pregnancies and foetal deaths when compared to later-onset GDM.
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Affiliation(s)
- M Saraiva
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - L Fonseca
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - T Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Vilaverde
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - M T Pereira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - F Pichel
- Department of Nutrition, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Pinto
- Department of Gynecology and Obstetrics, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - M C Almeida
- On Behalf of the Pregnancy and Diabetes Study Group of the Portuguese Diabetes Society, Coimbra, Portugal
| | - J Dores
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar E Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
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Paredes S, Fonseca L, Alves M, Vilaverde J, Oliveira J, Palma I. Lipid goals in patients with metabolic syndrome – Is low-density lipoprotein-cholesterol enough? Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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