Endocrine Abstracts

Background: Pregnant women with gestational diabetes (GD) have a higher risk of perinatal complication compared to women without. Nevertheless, in women with GD, predictors of perinatal complication are not well established. We aimed to compare, in women with GD, those with and without perinatal complications and to study predictors of perinatal complications in women with GD.

Methods: Retrospective study of pregnant women followed in the Endocrinology clinic of Centro Hospitalar de Trás-os-Montes e Alto Douro who had a childbirth in 2016. GD diabetes defined as fasting glycaemia ≥92 mg/dl in the first trimester or a 7g-OGTT at 24–28 weeks with at least one abnormal value (≥92; ≥180 or ≥153 mg/dl at 0, 60 or 120 min, respectively). HbA1c used was the closest to the end of pregnancy available. Perinatal complications defined as a combination of preeclampsia, polyhydramnios, fetal macrosomia, preterm labour (≤37 weeks), neonatal hypoglycemia, neonatal hyperbilirubinemia, neonatal distress respiratory syndrome, or trauma during delivery. We compared women with and without perinatal complications: χ² test, student t test and Mann Whitney U test. A multivariate logistic regression analysis was built to study predictors of perinatal complications.

Results: We studied 104 women, 27 with perinatal complications. Mean age was 34 years, 37.5% had a college degree. Mean body mass index before pregnancy was 26.2±5.3 kg/m² with a mean weight gain at the first appointment and at delivery of 8.2 kg and 11.1 kg, respectively. Median time between diagnosis and first appointment was 5 (3–9) weeks and the diagnosis of GD was made in the first trimester in 39.4%. Mean HbA1c was 5.2±0.4% and 44.2% needed treatment with metformin and/or insulin. Cesarean delivery rate was 37.5%. There were no significant differences between pregnant women with and without perinatal complications except in the birth weight that was lower in those with complications (2896±628 vs 3188±390; P=0.03). In the multivariate logistic regression analysis (variables included: age; college degree; time to fist appointment; GD diagnosed in the first trimester; metformin and/or insulin treatment, and HbA1c), only a college degree was an independent predictor of perinatal complications, OR 3.35 (95% IC: 1.23–9.12), P=0.02.

Conclusions: Pregnant women with GD with and without perinatal complications have similar social, anthropometric and clinical characteristics. The only variable associated with perinatal complications was having a college degree. Pregnant women with a college degree had more than three times the risk of perinatal complications.