CL_IV_L: Clinical Medicine IV. Lectures
Gergely Á. Visolyi1,2,3, Attila Kun4, Ádám G. Tabák3,5,6
1 Bajcsy-Zsilinszky Teaching Hospital, Budapest, Hungary
2 Károly Rácz School of PhD Studies, Semmelweis University, Budapest Hungary
3 Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
4 Tolna County Balassa János Hospital, Department of Obstetrics and Gynaecology, Szekszárd
5 Department of Epidemiology and Public Health, University College London, London, United Kingdom
6 Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
Introduction – Based on the HAPO (Hypoglycemia and Adverse Pregnancy Outcomes) study results, WHO issued new recommendations for the diagnosis of gestational diabetes mellitus (GDM) in 2013. While the use of the new diagnostic criteria (not yet applied in Hungary) approximately doubles the prevalence of GDM, there are no Hungarian data on the pregnancy outcomes of untreated WHO 2013 GDM women.
Aims - We aimed to compare pregnancy outcomes of untreated WHO-GDM women and women with normal glucose tolerance (NGT).
Method - During a universal screening program in Western Hungary 4677 pregnant women had a 75 g OGTT with the determination of fasting, 60-minute and 120-minute glucose between 2009 and 2013. NGT was diagnosed in n=4113, untreated WHO-GDM in n=445 cases.
Results - Untreated WHO-GDM women were older (mean difference, SE: 1.6, 0.3 yrs), had higher fasting (1.0, 0.02), 60-minute (1.4, 0.11), and 120-minute (0.8, 0.07 mmol/l) blood glucose, and blood pressure (2.2, 0.5 / 1.4, 0.4 mmHg). Weight gain was similar in both groups (13.1, 0.3 vs. 13.0, 0.1 kg, p=0.90). GDM newborns were heavier (116, 26 g) and were more frequently macrosomic (>4000g, OR 1.64, 95%CI 1.23-2.20). Hypertension during pregnancy was more prevalent in the GDM group (OR 1,44, 95%CI 1,02-2,03), as well as induced delivery (OR 1.34, 95%CI 1.10-1.64), forceps or vacuum use (OR 1.31, 95%CI 1.08-1.60), and acute cesarian section (OR 1.34, 95%CI 1.10-1.64). All these differences became non-significant after adjustment for maternal weight at delivery.
Conclusion - Pregnancy outcomes of WHO-GDM women were worse compared to normal glucose tolerant women however these differences were explained by the BMI difference between groups. Randomized controlled trials are required to investigate whether treatment targeting glycemic or weight measures would improve their outcomes.
Funding – The authors received no specific funding for this work.
Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine