Abstract
Objective Gestational diabetes mellitus (GDM) is associated with a higher risk of perinatal
morbidity and mortality, and its main complication is the occurrence of large for
gestational age (LGA) newborns. The present study aims to characterize pregnant women
with GDM and to identify factors associated with the occurrence of LGA newborns in
this population.
Methods A cross-sectional study was performed based on medical records of women whose prenatal
care and delivery were performed at the Maternal and Child Unit of the Hospital Universitário
of the Universidade Federal do Maranhão, state of Maranhão, Brazil. A total of 116
pregnant women diagnosed with GDM were included according to the criteria of the International
Association of Diabetes and Pregnancy Study Groups (IADPSG).
Results The variables associated with LGA newborns after multivariate analysis were: obesity
prior to pregnancy (OR = 11.6; 95% CI: 1.40–95.9), previous macrosomia (OR = 34.7;
95% CI: 4.08–295.3), high blood glucose levels in the 3rd trimester (OR = 2,67; 95% CI: 1.01–7.12) and combined change in the oral glucose
tolerance test (OGTT) (fasting + postdextrose) (OR = 3.53; 95% CI: 1.25–14.2) = 1.17–10.6).
Otherwise, insufficient weight gain during pregnancy reduced the risk for LGA newborns
(OR = 0.04; 95% CI: 0.01–0.32).
Conclusion Obesity prior to pregnancy, previous macrosomia, high blood glucose levels in the
3rd trimester, and combined change in the OGTT were independent predictive factors for
LGA newborns in pregnant women with GDM.
Resumo
Objetivo Diabetes mellitus gestacional (DMG) está associado a um maior risco de morbidade
e mortalidade perinatais, e sua principal complicação é a ocorrência de recém-nascidos
grandes para idade gestacional (GIG). O presente estudo visa caracterizar as gestantes
com DMG e identificar fatores associados à ocorrência de recém-nascidos GIG nesta
população.
Métodos Estudo transversal realizado a partir da coleta de dados de prontuário de mulheres
cujo acompanhamento pré-natal e parto foram realizados na Unidade Materno-Infantil
do Hospital Universitário da Universidade Federal do Maranhão, MA, Brasil. Foram incluídas
116 gestantes diagnosticadas com DMG pelo critério do International Association of
Diabetes and Pregnancy Study Groups (IADPSG).
Resultados As variáveis associadas à GIG após análise multivariada foram: obesidade pré-gestacional
(OR= 11,6; IC 95%: 1,40–95,9), macrossomia anterior (OR = 34,7; IC 95%: 4,08–295,3),
glicemia em jejum elevada no 3° trimestre (OR = 2,67; IC 95%: 1,01–7,12) e alteração
combinada no teste de tolerância oral à glicose (jejum + pós-dextrose) (OR= 3,53;
IC 95%: 1,17–10,6). Ganho de peso inferior reduziu o risco para GIG (OR= 0,04; IC
95%: 0,01–0,32).
Conclusão Obesidade anterior à gestação, macrossomia prévia, níveis elevados de glicose no
sangue no 3° trimestre e alteração combinada no TOTG foram fatores preditivos independentes
para os recém-nascidos GIG em gestantes com DMG.
Keywords
gestational diabetes mellitus - oral glucose tolerance test - large for gestational
age
Palavras-chave
diabetes mellitus gestacional - teste oral de tolerância à glucose - grande para idade
gestacional