PERINATAL COMPLICATIONS FOLLOWING GESTATIONAL DIABETES-MELLITUS HOW SWEET IS ILL

Objective. We tested the effect of patient compliance, fasting plasma glucose on oral glucose tolerance test, maternal body constitution, an d the method of treatment (diet versus insulin) on the perinatal outco me of patients with gestational diabetes mellitus. Study Design. A pro spective, population-based study compared the perinatal outcome of pat ients with gestational diabetes mellitus (n=470) (diabetic with regard to the parameters specified above) and a contemporaneous control grou p (nondiabetic, n=250). Results. The diabetic and control groups were matched in demographic characteristics. Patient compliance reduced the rate of macrosomia (14.4%) and neonatal hypoglycemia (3.4%) but not t o the levels of the control group (5.2% and 1.2% respectively, p<0.05) . The level of fasting plasma glucose on the oral glucose tolerance te st had no effect on perinatal outcome. Intensified (insulin) treatment reduced the rate of macrosomia and large-for-gestational age infants in the subgroups with intermediate and high levels of fasting plasma g lucose on the oral glucose tolerance test (9.5%/14.2% and 12.2%/24.2% respectively), again not to levels of the control group (5.2%/10.8%). Obese patients were found to have more perinatal complications than le an patients. Intensified (insulin) treatment has proved to be benefici al in terms of reducing the rate of perinatal complications in the obe se patients, but not to the corresponding levels of the control group. Such treatment had no effect on the lean patients. Conclusions. Stric t control of maternal hyperglycemia and high patient compliance are im perative for an effective reduction of perinatal complication in patie nts with gestational diabetes mellitus. The desired plasma glucose lev el in the glycemic control of these patients should be further reduced , thus bringing the rate of perinatal complications to that of the nor mal population.