title: Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: persistent macrosomia relates to maternal pre-pregnancy overweight.
abstract: 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.
authors.affiliation: Department of Nutrition, Diabetes & Metabolism, Pontificia Universidad Católica de Chile, Santiago, Chile. polmos@med.puc.cl
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Olmos
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Araya-Del-Pino
authors.forename: Cristián A
authors.initials: CA
authors.lastname: González-Carvello
authors.forename: Pablo
authors.initials: P
authors.lastname: Laso-Ulloa
authors.forename: María I
authors.initials: MI
authors.lastname: Hodgson
authors.forename: Verónica
authors.initials: V
authors.lastname: Irribarra
authors.forename: Gisella R
authors.initials: GR
authors.lastname: Borzone
authors.forename: Cristián
authors.initials: C
authors.lastname: Belmar
authors.forename: Andrés
authors.initials: A
authors.lastname: Poblete
authors.forename: Cecilia
authors.initials: C
authors.lastname: Berríos
authors.forename: Jorge
authors.initials: J
authors.lastname: Becker
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Zajer-Amar
authors.forename: Alejandro
authors.initials: A
authors.lastname: Manzur
authors.forename: Milan
authors.initials: M
authors.lastname: Bozinovic
authors.forename: Ramón J
authors.initials: RJ
authors.lastname: Miranda
authors.forename: Alberto
authors.initials: A
authors.lastname: Diez
authors.forename: Hernán
authors.initials: H
authors.lastname: Vidal
authors.forename: Renato
authors.initials: R
authors.lastname: Ramírez-Armijo
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Olmos
authors.forename: Cristián
authors.initials: C
authors.lastname: Tabilo
authors.forename: Jessica
authors.initials: J
authors.lastname: Ahuad
mesh_terms: 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*
chemical_list: D006442:Glycated Hemoglobin