Gestational diabetes mellitus in Italy: a multicenter study

Annunziata Lapolla, Maria Grazia Dalfrà, Matteo Bonomo, Elena Parretti, Domenico Mannino, Giorgio Mello, Graziano Di Cianni et al.
European Journal of Obstetrics, Gynecology, and Reproductive Biology 2009, 145 (2): 149-53

OBJECTIVE: This prospective study evaluated the impact of gestational diabetes on maternal and fetal outcome in a large cohort of women with gestational diabetes mellitus (GDM) followed up using standardized clinical criteria.

STUDY DESIGN: Between 1999 and 2003, we collected 3465 GDM women from 31 Italian regional obstetric or diabetes centers, recording the time and mode of delivery, gestational hypertension, pre-eclampsia, eclampsia, congenital malformations, and neonatal mortality, comparing findings with the Italian general pregnant population.

RESULTS: The rate of cesarean sections was 34.9% and macrosomia 8.7% (33.2 and 7.4%, respectively, in the general population, p=ns). The stillbirth and neonatal mortality rates were no different in GDM patients and normal pregnancies (0.34% vs. 0.30%, p=0.176 and 0.29% vs. 0.32%, p=0.748), but the former had twice as many newborn with congenital malformations (2.05% vs. 0.89%, p<0.01; CI 1.64-2.62). A prognostic model for the outcome of pregnancy was built and the concurrent occurrence of several conditions was deemed as a positive outcome. Pregnancies which did not meet one or more of the above criteria were classified as "complicated". On multivariate logistic analysis, only the week of gestation when GDM was diagnosed and prepregnancy BMI were independent predictors of a complicated pregnancy.

CONCLUSION: When correctly diagnosed and treated during pregnancy, women with GDM have a pregnancy outcome similar to the general pregnant population, except for a greater likelihood of congenital malformations in the newborn, probably due to unrecognized prior diabetes. Prepregnancy obesity plays an important part in raising the risk of adverse perinatal outcomes in GDM patients.

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