Many of the conditions previously classified as minor alterations of glucose tolerance in pregnancy are now included in a single category labeled as gestational diabetes (GDM). The therapeutic approach for women with GDM may be differentiated on the basis of the degree of GDM "severity", not only as the degree of impaired glucose, but as the overall risk of adverse neonata! outcomes. The study aimed to assess the risk of adverse neonata! outcomes in women with GDM by identifying subgroups of women at higher risk in order to recognize the characteristics most associated with an excess of risk. This was an observational, retrospective, multicenter study involving women with pregnancy complicated by GDM in ltaly treated at main diabetes centers in the period between January 2012 and June 2015. Overall, 2045 pregnancies (mean age 37.4 (33.8-40.8) years, pre-gestational BMI 24.6 (21.9-28.6) kg/m2, 38.1% insulin treated) were analyzed. Two miscarriages but no materna! or neonata! deaths were recorded. Women with a composite adverse neonata! outcome (25.9%) had higher pre-gestational BMI (p=0,006), second (p=0,002) and third (p=0,03) trimester HbAle levels, OGTT basai glucose levels and previous macrosomia rate (p<0,0001) when compared with women without adverse outcomes. The occurrence of the composite adverse outcome was associated with previous macrosomia (OR 2.53 95%CI 1.52-4.22) and obesity (OR 1.45 95%CI 1.07-1.96). Our study suggests the relevance of risk stratification in order to identify subgroups of women at higher risk of adverse neonata! outcome.
The Risk Stratification of Adverse Neonatal Outcomes in Women with Gestational Diabetes (STRONG) Study: A Preliminary Report
VITACOLONNA, Ester;
2017-01-01
Abstract
Many of the conditions previously classified as minor alterations of glucose tolerance in pregnancy are now included in a single category labeled as gestational diabetes (GDM). The therapeutic approach for women with GDM may be differentiated on the basis of the degree of GDM "severity", not only as the degree of impaired glucose, but as the overall risk of adverse neonata! outcomes. The study aimed to assess the risk of adverse neonata! outcomes in women with GDM by identifying subgroups of women at higher risk in order to recognize the characteristics most associated with an excess of risk. This was an observational, retrospective, multicenter study involving women with pregnancy complicated by GDM in ltaly treated at main diabetes centers in the period between January 2012 and June 2015. Overall, 2045 pregnancies (mean age 37.4 (33.8-40.8) years, pre-gestational BMI 24.6 (21.9-28.6) kg/m2, 38.1% insulin treated) were analyzed. Two miscarriages but no materna! or neonata! deaths were recorded. Women with a composite adverse neonata! outcome (25.9%) had higher pre-gestational BMI (p=0,006), second (p=0,002) and third (p=0,03) trimester HbAle levels, OGTT basai glucose levels and previous macrosomia rate (p<0,0001) when compared with women without adverse outcomes. The occurrence of the composite adverse outcome was associated with previous macrosomia (OR 2.53 95%CI 1.52-4.22) and obesity (OR 1.45 95%CI 1.07-1.96). Our study suggests the relevance of risk stratification in order to identify subgroups of women at higher risk of adverse neonata! outcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
