EARLY GLYCEMIC CONTROL REDUCES LARGE-FOR-GESTATIONAL-AGE INFANTS IN 250 JAPANESE GESTATIONAL DIABETES PREGNANCIES

Hiroshi Sameshima; Masato Kamitomo; Shoko Kajiya; Motoaki Kai; Seishi Furukawa; Tsuyomu Ikenoue

doi:10.1055/s-2000-13450

American Journal of Perinatology, Table of Contents

Am J Perinatol 2000; 17(7): 371-376
DOI: 10.1055/s-2000-13450

EARLY GLYCEMIC CONTROL REDUCES LARGE-FOR-GESTATIONAL-AGE INFANTS IN 250 JAPANESE GESTATIONAL DIABETES PREGNANCIES

Hiroshi Sameshima¹ , Masato Kamitomo² , Shoko Kajiya² , Motoaki Kai² , Seishi Furukawa¹ , Tsuyomu Ikenoue¹

¹Perinatal Center and Department of Obstetrics & Gynecology, Miyazaki Medical College, Miyazaki, Japan;
²Department of Obstetrics & Gynecology, Kagoshima City Hospital, Kagoshima City, Japan

Abstract

ABSTRACT

Our objective was to test if tight glycemic control versus loose glycemic control in gestational diabetic patients and a gestational age of < 32 weeks influence fetal growth, fetal distress, and neonatal complication. We performed a retrospective study with 250 gestational diabetes mellitus in Japanese women. Two groups were categorized according to the timing at which good maternal glycemic control was attained at < 32 weeks and kept so until delivery (group 1) and > 32 weeks or never until delivery (group 2). In these two groups, neonatal growth (large-for-gestational age: LGA; appropriate- : AGA; and small- : SGA), neonatal complications (hypoglycemia, jaundice, polycythemia, and cumulative incidence), and incidence of fetal distress were compared. The χ² test, unpaired t test, one-way analysis of variance (ANOVA) and multiple logistic regression analyses were used for statistical analyses. Maternal age, height, prepregnancy body mass index (BMI), gestational age at delivery were not different between the groups. In group 2 (> 32 weeks), LGA, macrosomia (> 4 kg), neonatal hypoglycemia was significantly increased compared with those in group 1. Incidence of SGA, fetal distress, and neonatal jaundice were not different between the groups. Multiple logistic regression analysis for LGA showed significant relation to timing of maternal glycemic control. We concluded that good glycemic control should be attained at < 32 weeks and maintained until delivery to reduce LGA infants and neonatal hypoglycemia in gestational diabetes mellitus. This management did not appear to decrease SGA infants or fetal distress.

KEYWORD

Gestational diabetes mellitus - glycemic control - large-for-gestational age - neonatal complications

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References

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