Occurrence of gestational diabetes mellitus, maternal and fetal outcomes beyond the 28th week of gestation in women at high risk of gestational diabetes. A prospective study.
OBJECTIVE
Among the numerous guidelines defining the diagnostic strategy of gestational diabetes mellitus (GDM), none of them suggest a follow-up in women with risk factors beyond the 28th week of gestation (WG). The primary objective of this study was to assess the incidence of GDM beyond 28 WG in a group of women at high risk. The secondary objectives were to evaluate maternal and fetal outcomes in early and late GDM (between 24-28 WG, and beyond 28 WG), as well as to compare them to a normal glucose tolerance (NGT) group.


METHODS
A prospective study conducted in 191 consecutive women. Between 24-28 WG, the diagnosis of GDM was performed in a two-step approach (50 then 75 g). Beyond the 28 WG, the diagnosis of GDM was based on self-monitoring blood glucose (SMBG). All women were educated about an individualized diabetic diet and to perform SMBG daily glucose profiles.


RESULTS
Seventy-two percent of the women at risk had developed GDM. Among these, 54% had developed early GDM, between 24-28 WG, and 18% had developed late GDM, beyond the 28th WG. Gestational age of late GDM was estimated 30 WG. In late GDM, onset of diabetes seems to be predicted by an increase in capillary glucose value determined at 22:00 hours, but this needs to be confirmed. Women who develop GDM2 have a significantly higher rate of macrosomia and more important pre-pregnancy overweight, underlining this impact in the occurrence of macrosomia. Finally maternal outcomes were not different in the 3 groups with intensive intervention.
Virally
M
M
Department of Medicine B, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (APHP), University Paris-VII, 2 rue Ambroise-Paré, 75010 Paris, France. marie.virally@lrb.aphp.fr
Laloi-Michelin
M
M
Meas
T
T
Ciraru
N
N
Ouled
N
N
Médeau
V
V
Kevorkian
J P
JP
Truc
J B
JB
Guillausseau
P J
PJ
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D017063:Outcome Assessment, Health Care; D010298:Parity; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose