Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil

Sampaio, Yanara; Porto, Lara Benigno; Lauand, Thais Cabral Gomes; Marcon, Larissa Pereira; Pedrosa, Hermelinda Cordeiro

doi:10.20945/2359-3997000000310

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Archives of Endocrinology and Metabolism

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Original Article • Arch. Endocrinol. Metab. 65 (1) • Feb 2021 • https://doi.org/10.20945/2359-3997000000310 copy

Gestational diabetes and overt diabetes first diagnosed in pregnancy: characteristics, therapeutic approach and perinatal outcomes in a public healthcare referral center in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil.

Materials and methods:

A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted.

Results:

Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%).

Conclusions:

Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Keywords
Gestational diabetes mellitus; overt diabetes; pregnancy; insulin; perinatal outcomes

Characteristics	Overall (n = 224)	GDM (n = 176)	OD (n = 48)	P-value^* * P-values were based on Mann-Whitney test (skewed continuous variables) or chi-square test (categorical variables).
Age (years)^a a Values expressed as median (± interquartile range).	33.00 (±7.00)	33.00 (±7.00)	31.00 (±10.00)	0.267
GA at diagnosis (weeks)^a a Values expressed as median (± interquartile range).	26.00 (±9.00)	26.00 (±9.00)	26.07 (±8.46)	0.765
GA at first appointment (weeks)^a a Values expressed as median (± interquartile range).	32.57 (±6.36)	32.86 (±6.57)	32.21 (±6.25)	0.243
Pre-gestational BMI (kg/m²)^a a Values expressed as median (± interquartile range).	28.00 (±7.54)	27.97 (±7.94)	28.40 (±6.35)	0.353
Gestational weight gain (kg)^a a Values expressed as median (± interquartile range).	8.15 (±7.40)	8.00 (±6.80)	9.30 (±8.70)	0.445
Need for insulin therapy^b b Values expressed as proportion n (%).	96 (42.8)	67 (38.1)	29 (60.4)	0.006^ P-value < 0.05. Number of patients who needed insulin therapy and doses of insulin were significantly different through the comparison between GDM and OD groups.
Initial dose of insulin IU/kg^a a Values expressed as median (± interquartile range).	0.23 (±0.39)	0.17 (±0.25)	0.53 (±0.56)	<0.001^ P-value < 0.05. Number of patients who needed insulin therapy and doses of insulin were significantly different through the comparison between GDM and OD groups.
Final dose of insulin IU/kg^a a Values expressed as median (± interquartile range).	0.28 (±0.44)	0.19 (±0.29)	0.55 (±0.53)	0.002^ P-value < 0.05. Number of patients who needed insulin therapy and doses of insulin were significantly different through the comparison between GDM and OD groups.

	Insulin-treated group (n = 96)	Non-insulin-treated group (n = 128)	P-value^* * P-values were based on Mann-Whitney test (skewed continuous variables) or chi-square test (categorical variables).
Age (years)^a a Values expressed as median (± interquartile range).	34.00 (±9.00)	32.00 (±7.00)	0.407
GA at diagnosis (weeks)^a a Values expressed as median (± interquartile range).	26.00 (±8.86)	26.00 (±8.75)	0.828
GA at 1st appointment (weeks)^a a Values expressed as median (± interquartile range).	32.43 (±6.50)	32.71 (±6.25)	0.478
Pre-gestational BMI (kg/m²)^a a Values expressed as median (± interquartile range).	28.32 (±6.40)	27.57 (±8.07)	0.201
Gestational weight gain (kg)^a a Values expressed as median (± interquartile range).	9.35 (±6.90)	6.90 (±7.00)	0.038^ p < 0.05.
FPG at diagnosis (mg/dL)^a a Values expressed as median (± interquartile range).	98.00 (±26.00)	93.00 (±18.00)	0.004^ p < 0.05.
2-h plasma glucose on OGTT (mg/dL)^a a Values expressed as median (± interquartile range).	167.50 (±38.00)	165.00 (±25.00)	0.033^ p < 0.05.
Overt diabetes frequency^b b Values expressed as proportion n (%).	29 (30.2)	19 (14.8)	0.006^ p < 0.05.

Perinatal Outcomes	Overall (n = 139)	GDM group (n = 105)	OD group (n = 34)
Birth Weight (g)^a a Values expressed as mean (± standard deviation). ^* * P-value = 0.552 (Result obtained from Student's t-test) when comparing GDM vs. OD. Differences in the other outcomes were not evaluated because of the small number of patients with complications in each group.	3,266.24 ± 468.61	3,279.21 ± 411.21	3,222.66 ± 610.66
LGA (n)^b b Values expressed as proportion n (%).	22 (15.83)	14 (13.33)	8 (23.53)
Macrosomia (n)^b b Values expressed as proportion n (%).	3 (2.15)	1 (0.95)	2 (5.88)
Need for ICU (n)^b b Values expressed as proportion n (%).	6 (4.32)	2 (1.90)	4 (11.76)
Apgar score ≤ 7 (n)^b b Values expressed as proportion n (%).	9 (6.47)	6 (5.71)	3 (8.82)
Hypoglycemia (n)^b b Values expressed as proportion n (%).	20 (14.39)	12 (11.43)	8 (23.53)
Clinical jaundice (n)^b b Values expressed as proportion n (%).	23 (16.55)	17 (16.19)	6 (17.64)

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[1] Correspondence to: Lara Benigno Porto, Unidade de Endocrinologia, Hospital Regional de TaguatingaSt. B Norte Área Especial 24 – 72120-970 – Taguatinga, Brasília, DF, Brasil. larabporto@yahoo.com.br