title: Gestational diabetes and pre-pregnancy overweight: possible factors involved in newborn macrosomia.
abstract: OBJECTIVE
  Good glycemic control in gestational diabetes mellitus (GDM) seems not to be enough to prevent macrosomia (large-for-gestational-age newborns). In GDM pregnancies we studied the effects of glycemic control (as glycosylated hemoglobin [HbA1c]), pre-pregnancy body mass index (PP-BMI) and gestational weight gain per week (GWG-W) on the frequency of macrosomia.
  
  
  METHODS
  We studied 251 GDM pregnancies, divided into two groups: PP-BMI<25.0kg/m(2) (the non-overweight group; n=125), and PP-BMI≥25.0kg/m(2) (the overweight group; n=126). A newborn weight Z-score>1.28 was considered large-for-gestational-age. Statistical analysis was carried out using the Student's t-test and χ(2) -test, receiver-operator characteristic curves and linear and binary logistic regressions.
  
  
  RESULTS
  Prevalence of macrosomia was 14.9% among GDM (n=202/251, 88.4%) with good glycemic control (mean HbA1c<6.0%), and 28.1% in those with mean HbA1c≥6.0% (n=49/251, P<0.025). Macrosomia rates were 10.4% in the non-overweight group and 24.6% in the overweight group (P=0.00308), notwithstanding both having similar mean HbA1c (5.48±0.065 and 5.65±0.079%, P=0.269), and similar GWG-W (0.292±0.017 and 0.240±0.021kg/week, P=0.077). Binary logistic regressions showed that PP-BMI (P=0.012) and mean HbA1c (P=0.048), but not GWG-W (P=0.477), explained macrosomia.
  
  
  CONCLUSIONS
  Good glycemic control in GDM patients was not enough to reduce macrosomia to acceptable limits (<10% of newborns). PP-BMI and mean HbA1c (but not GWG-W) were significant predictors of macrosomia. Thus, without ceasing in our efforts to improve glycemic control during GDM pregnancies, patients with overweight/obesity need to be treated prior to becoming pregnant.
authors: Departments of Nutrition, Diabetes and Metabolism, College of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile. polmos@med.puc.cl
authors: Pablo Roberto
authors: PR
authors: Olmos
authors: Gisella Rosa
authors: GR
authors: Borzone
authors: Roberto Ignacio
authors: RI
authors: Olmos
authors: Claudio Nicolás
authors: CN
authors: Valencia
authors: Felipe Andrés
authors: FA
authors: Bravo
authors: María Isabel
authors: MI
authors: Hodgson
authors: Cristián Gastón
authors: CG
authors: Belmar
authors: José Andrés
authors: JA
authors: Poblete
authors: Manuel Orlando
authors: MO
authors: Escalona
authors: Bernardita
authors: B
authors: Gómez
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology*; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D050177:Overweight / Q000150:complications*; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D001786:Blood Glucose