Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: persistent macrosomia relates to maternal pre-pregnancy overweight.
After a 10-year program intending to improve glycemic control in diabetic pregnancies, we evaluated whether factors underlying macrosomia are similar for type-1 and -2 pregestational diabetic women.


METHODS
Twenty-three pregnancies in type-1 diabetics (PDM1, age 28.3+/-1.1 years) and 51 pregnancies in type-2 diabetics (PDM2, age 32.8+/-0.6 years) were followed and treated with intensified insulin therapy. Several factors potentially influencing macrosomia were evaluated.


METHODS
chi-square, Fisher's exact, Student's "t" and Mann-Whitney "U" tests, and ROC analysis.


RESULTS
In PDM1 and PDM2, respectively, large-for-gestational-age (LGA) frequencies were 26.08% and 37.25% (NS), antepartum HbA1c values were 6.5+/-0.32 and 6.1+/-0.16 (NS), and pre-pregnancy body mass indexes (BMI) were 23.03+/-0.66 and 30.01+/-0.89 (p<0.0001). In PDM1 the main predictor of LGA was an antepartum HbA1c> or =6.8% (p=0.046), whereas in PDM2 pregestational BMI> or =24 the variable associated (p=0.032) with LGA newborns.


CONCLUSIONS
PDM1 and PDM2 differ in the underlying factors related to macrosomia. Whereas in PDM1 the antepartum HbA1c emerged as the most significant variable, suggesting that glycemic control largely determines macrosomia, in PDM2 with near-optimal glycemic control, macrosomia related to pregestational BMI.
Olmos
Pablo R
PR
Department of Nutrition, Diabetes & Metabolism, Pontificia Universidad Católica de Chile, Santiago, Chile. polmos@med.puc.cl
Araya-Del-Pino
Andrea P
AP
González-Carvello
Cristián A
CA
Laso-Ulloa
Pablo
P
Hodgson
María I
MI
Irribarra
Verónica
V
Borzone
Gisella R
GR
Belmar
Cristián
C
Poblete
Andrés
A
Berríos
Cecilia
C
Becker
Jorge
J
Zajer-Amar
Claudia M
CM
Manzur
Alejandro
A
Bozinovic
Milan
M
Miranda
Ramón J
RJ
Diez
Alberto
A
Vidal
Hernán
H
Ramírez-Armijo
Renato
R
Olmos
Roberto I
RI
Tabilo
Cristián
C
Ahuad
Jessica
J
D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section; D002677:Chile; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D050177:Overweight / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology; D011254:Pregnancy in Diabetics / Q000097:blood*
D006442:Glycated Hemoglobin