Neonatal outcomes according to different therapies for gestational diabetes mellitus<sup>,</sup>

Silva, Amanda L. da; Amaral, Augusto R. do; Oliveira, Daniela S. de; Martins, Lisiane; Silva, Mariana R. e; Silva, Jean Carl

doi:10.1016/j.jped.2016.04.004

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Original articles • J. Pediatr. (Rio J.) 93 (1) • Jan/Feb 2017 • https://doi.org/10.1016/j.jped.2016.04.004 copy

Neonatal outcomes according to different therapies for gestational diabetes mellitus^☆ ☆ Please cite this article as: Silva AL, Amaral AR, Oliveira DS, Martins L, Silva MR, Silva JC. Neonatal outcomes according to different therapies for gestational diabetes mellitus. J Pediatr (Rio J). 2017;93:87-93. ^,^☆☆ ☆☆ Study carried out at Maternidade Darcy Vargas, Joinville, SC, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Objectives:

To compare different neonatal outcomes according to the different types of treatments used in the management of gestational diabetes mellitus.

Methods:

This was a retrospective cohort study. The study population comprised pregnant women with gestational diabetes treated at a public maternity hospital from July 2010 to August 2014. The study included women aged at least 18 years, with a singleton pregnancy, who met the criteria for gestational diabetes mellitus. Blood glucose levels, fetal abdominal circumference, body mass index and gestational age were considered for treatment decision-making. The evaluated neonatal outcomes were: type of delivery, prematurity, weight in relation to gestational age, Apgar at 1 and 5 min, and need for intensive care unit admission.

Results:

The sample consisted of 705 pregnant women. The neonatal outcomes were analyzed based on the treatment received. Women treated with metformin were less likely to have children who were small for gestational age (95% CI: 0.09-0.66) and more likely to have a newborn adequate for gestational age (95% CI: 1.12-3.94). Those women treated with insulin had a lower chance of having a preterm child (95% CI: 0.02-0.78). The combined treatment with insulin and metformin resulted in higher chance for a neonate to be born large for gestational age (95% CI: 1.14-11.15) and lower chance to be born preterm (95% CI: 0.01-0.71). The type of treatment did not affect the mode of delivery, Apgar score, and intensive care unit admission.

Conclusions:

The pediatrician in the delivery room can expect different outcomes for diabetic mothers based on the treatment received.

KEYWORDS
Gestational diabetes mellitus; Therapeutics; Outcomes

Variable	Mean	Standard deviation
Age	30.58	6.34
Number of gestations	2.65	1.67
Pre-gestational BMI	29.34	6.17
Gestational age^a a Gestational age at the first consultation in a gestational diabetes mellitus outpatient clinic.	28.53	7.09
Fasting glycemia^b b Mean values obtained during gestation.	89.23	13.65
Post-prandial glycemia^c c Mean values obtained during gestation.	117.08	17.57

Variables	Absolute number	%
Type of delivery
Vaginal	338	47.9
Cesarean section	367	52.1
Gestational age
Preterm	50	7.1
Full-term	654	92.7
Post-term	1	0.2
Weight
Macrosomia (≥4000 g)	13	1.9
Normal weight (2500-3999 g)	677	96
Low weight (<2500 g)	15	2.1
Weight vs. gestational age
SGA (<P10)	51	7.2
AGA (between P10 and P90)	540	76.6
LGA (>P90)	114	16.2
Apgar 1'
Low (<7)	40	5.7
Apgar 5'
Low (<7)	8	1.1
ICU admission
	36	5.1

Outcome	Therapeutic modality	n (%)	Crude OR (95% CI)	p	Adjusted OR^a a Adjusted OR for the following variables: maternal age, maternal body mass index, number of pregnancies, type of delivery, gestational age at first consultation, mean fasting glucose, mean postprandial blood glucose, and fetal abdominal circumference (considered between 28 and 32 weeks gestation). (95% CI)	p
Cesarean section	Diet	137 (37.3%)	-	-	-	-
	Metformin	128 (34.8%)	1.221 (0.871-1.171)	0.247	0.665 (0.370-1.194)	0.172
	Insulin	68 (18.5%)	2.066 (1.306-3.268)	0.002	1.426 (0.629-3.231)	0.395
	Metformin + insulin	34 (9.2%)	1.784 (0.996-3.197)	0.052	0.891 (0.305-2.607)	0.833
Preterm birth	Diet	28 (56%)	-	-	-	-
	Metformin	17 (34%)	0.694 (0.370-1.299)	0.253	0.429 (0.173-1.064)	0.068
	Insulin	3 (6%)	0.276 (0.082-0.926)	0.037	0.133 (0.023-0.789)	0.026
	Metformin + insulin	2 (4%)	0.351 (0.081-1.516)	0.161	0.105 (0.015-0.713)	0.021
SGA	Diet	34 (66.6%)	-	-	-	-
	Metformin	13 (25.4%)	0.420 (0.216-0.814)	0.010	0.253 (0.096-0.666)	0.005
	Insulin	3 (5.8%)	0.222 (0.067-0.738)	0.014	0.179 (0.027-1.197)	0.076
	Metformin + insulin	1 (1.9%)	0.139 (0.019-1.033)	0.054	0.191 (0.017-2.163)	0.181
AGA	Diet	230 (42.59%)	-	-	-	-
	Metformin	204 (37.77%)	1.267 (0.828-1.939)	0.276	2.103 (1.121-3.945)	0.021
	Insulin	73 (13.51%)	0.618 (0.377-1.015)	0.057	1.306 (0.579-2.947)	0.520
	Metformin + insulin	33 (6.11%)	0.401 (0.220-0.731)	0.003	0.612 (0.230-1.634)	0.327
LGA	Diet	30 (26.31%)	-	-	-	-
	Metformin	32 (28.07%)	1.293 (0.761-2.195)	0.342	0.891 (0.375-2.115)	0.793
	Insulin	30 (26.31%)	3.461 (1.963-6.100)	0.000	1.591 (0.590-4.290)	0.358
	Metformin + insulin	22 (19.29%)	5.673 (2.944-10.931)	0.000	3.567 (1.141-11.150)	0.029
Apgar 1' < 7	Diet	15 (37.5%)	-	-	-	-
	Metformin	17 (42.5%)	1.38 (0.664-2.778)	0.402	1.742 (0.516-5.878)	0.371
	Insulin	6 (15%)	1.112 (0.40-2.945)	0.831	0.564 (0.098-3.245)	0.521
	Metformin + insulin	2 (5%)	0.686 (0.153-3.088)	0.624	0.711 (0.091-5.543)	0.745
Apgar 5' < 7	Diet	5 (62.5%)	-	-	-	-
	Metformin	1 (12.5%)	0.291 (0.032-2.624)	0.271	0.537 (0.025-11.527)	0.691
	Insulin	0	0	0.989	0	0.998
	Metformin + insulin	2 (25%)	2.676 (0.478-14.975)	0.263	2.111 (0.061-73.137)	0.680
ICU	Diet	15 (41.66%)	-	-	-	-
	Metformin	10 (27.77%)	0.775 (0.342-1.758)	0.543	0.625 (0.178-2.196)	0.464
	Insulin	3 (8.33%)	0.540 (0.153-1.903)	0.338	0.079 (0.005-1.150)	0.063
	Metformin + insulin	8 (22.22%)	3.089 (1.242-7.682)	0.015	1.156 (0.215-6.212)	1.156

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[1] * Corresponding author. E-mail:Mandinha4265@hotmail.com (A.L. Silva).