[Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers].
Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies and results in an increased incidence of Caesarean sections, perinatal traumas and neonatal complications. Macrosomy, i.e., an excessive birth-weight is observed in newborns from these pregnancies. In the majority of cases, diabetes regression is observed directly after pregnancy termination, however, in 15-60% of these patients, diabetes mellitus develops in later years of life. The goal of the study was an assessment of the risk factors for GDM development in gestation, perinatal macrosomy in offspring from GDM-affected pregnancies and overt diabetes mellitus in women after GDM. MATERIAL AND METHODS. The study involved 146 women with GDM and 1806 women with normal carbohydrate metabolism during pregnancy, 506 newborns of gestational diabetic mothers and 993 newborns of healthy mothers, as well as 200 women with a history of GDM during the years 1990-1999 (the mean time period after GDM - 3.1 +/- 6.0 years). The recognized risk factors of GDM and perinatal macrosomy were evaluated, together with the incidence of overt diabetes mellitus after GDM-affected pregnancy.


RESULTS
An analysis of multifactor logistic regression demonstrated that the independent risk factors for GDM include: BMI 3 25 kg/m2 before pregnancy (OR - 2.38), the history of diabetes in family (OR - 1.67), and the third pr further pregnancy (OR - 1.81) - p < 0.05. In turn, experienced obstetric failures and delivery of child with macrosomy features revealed insignificant - p > 0.05. Perinatal macrosomy correlated with mother's BMI and glycaemia during the 2nd hour of diagnostic test (75 g OGTT). No correlations were observed among mother's age, fasting glycaemia levels and HbA1c in mothers. In the group of GDM-affected women, diabetes mellitus type 2 was diagnosed in 34 (17.0%) patients. The the actual BMI > 25 kg/m2 and glycaemia values in the 2nd hour of diagnostic test in the course of GDM diagnosis (p < 0.05). The risk of diabetes was not enhanced in that group of women by family history of diabetes, the age of GDM onset (< 25 years of life), the week of gestation when GDM was diagnosed (< 25 hbd), and the type of GDM therapy (insulin vs. diet) p > 0.05


CONCLUSIONS
Overweight and obesity are both risk factors of gestational diabetes mellitus, delivery of child with macrosomy features and of overt diabetes mellitus later in life.
Cypryk
Katarzyna
K
Klinika Endokrynologii i Terapii Izotopowej, Uniwersytetu Medycznego, Instytut Centrum Zdrowia Matki Polki w Lodzi. kcypryk@mp.pl
Pertyńska-Marczewska
Magdalena
M
Szymczak
Wiesław
W
Zawodniak-Szałapska
Małgorzata
M
Wilczyński
Jan
J
Lewiński
Andrzej
A
D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D016640:Diabetes, Gestational / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D012307:Risk Factors