Endocrine Abstracts

Background: The incidence of gestational diabetes mellitus (GDM) is increasing worldwide, with considerable impact on the health of both mother and newborn. There is no doubt that screening for GDM between 24 and 28 gestational weeks (GWks) is important to reduce the risk of adverse outcomes; however, there is no clear consensus about the diagnosis and treatment of GDM in early pregnancy.

Aims: To evaluate the effect of time of GDM diagnosis (early onset (EO, 16–18 GWks) vs late onset (LO, 24–28 GWks)) on fetal outcomes.

Materials and methods: We retrospectively evaluated 1369 women with GDM followed at our Center. Diagnosis of GDM was performed by an oral glucose tolerance test (OGTT) at 16–18 GWks (n=321) or at 24–28 GWks (n=1048). Neonatal outcomes were macrosomia, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia and neonatal cardiac hypertrophy. Self-monitoring of blood glucose (SMBG) data and insulin therapy at last visit were also assessed.

Results: No differences between groups were found in the need for insulin therapy (EO 48,5% vs LO 33,4%, P=NS) or in SMBG parameters. Considering all pregnancies, 18,3% were complicated with macrosomia; 10,7% of newborns had neonatal hypoglycemia and 20,5% had cardiac hypertrophy, while no NICU admission was observed in either group. In both groups, neonatal hypoglycemia correlated with poor glucose control at the last visit (less than 50% of SMBG measurements in target). In the LO group, we found a higher risk to develop macrosomia (+38.6%, P<0.003) or cardiac hypertrophy (+31.4%, P<0.01) compared to EO group. Interestingly, we observed that 23% of women in LO group presented the risk factors suggesting to perform an early OGTT, that was lost for different reasons. In this subgroup, 63% of women had at least one neonatal adverse outcome.

Conclsions: High risk women should be screened as early as possible and an early treatment may have a significant effect to improve fetal outcomes.