NEONATAL OUTCOME AND OBSTETRIC COMPLICATIONS IN WOMEN WITH GESTATIONAL DIABETES - EFFECTS OF MATERNAL BODY-MASS INDEX

OBJECTIVE: To evaluate in a selected population the clinical character istics (time of diagnosis. different treatment, metabolic parameters, etc.) of gestational diabetes in relation to prepregnancy body mass in dex (BMI)and the influence of BMI on neonatal outcome. DESIGN: This st udy was retrospectively led using a computerized data system for all d eliveries that occurred at the Departments of Obstetrics and Gynecolog y of the University of Pisa (Italy) from 1 January 1987 to 31 December 1992. SUBJECTS: 93 women with GDM and 110 control subjects divided in to three groups according to their pre-pregnancy BMI: normal weight (N w), overweight (Owl and obese (Ob). MEASUREMENTS: Time of diagnosis. m ode of treatment and metabolic control of GDM; time and mode of delive ry, neonatal outcome (macrosomia, respiratory distress syndrome, hyper bilirubinemia, hypoglycemia, polycythemia, hypocalcemia). RESULTS: GDM was diagnosed earlier in Ow and Ob than in Nw (p < 0.01) and insulin treatment was used in 86% of Ob-GDM, 91% of Ow-GDM and in 77% of Nw-GD M women (p < 0.001). Preterm deliveries and cesarean sections resulted significantly increased in all BMI categories of GDM patients with re spect to matched normal controls. Prevalence of neonatal macrosomia wa s higher in GDM patients (44.6%) compared with normal controls (15.4%) and correlated (p > 0.01) with prepregnancy BMI in both groups. The b ody weight increase during pregnancy was not associated with neonatal macrosomia. CONCLUSIONS: The degree of overweight is associated with a n earlier diagnosis of GDM; prepregnancy BMI is more predictive of mac rosomia than weight gain, both in control and GDM women; GDM seems to play the most important role in increasing the possibility of the occu rrence of macrosomia.