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[Neonatal Morbidity and Gestational Diabetes: Coincidence or Consequence of the 2011 Protocol]
Gabriela Mimoso1, Guiomar Oliveira2
1Serviço de Neonatologia. Maternidade Bissaya Barreto. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Insights
Early diagnosis of gestational diabetes (GDM) and strict metabolic control increased neonatal complications, including hypoglycemia and congenital anomalies. Further national data analysis is needed to understand this trend.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Endocrinology
Background:
- Gestational diabetes (GDM) is a pregnancy complication linked to increased perinatal risks.
- Effective metabolic control in GDM is crucial for reducing adverse outcomes.
- Recent diagnostic criteria allow for earlier GDM detection, even in the first trimester.
Purpose of the Study:
- To compare neonatal morbidity in pregnancies with GDM diagnosed before and after the 2011 Portuguese guidelines.
- To evaluate the impact of updated diagnostic criteria on perinatal outcomes.
Main Methods:
- Retrospective analysis of 774 unifetal pregnancies complicated by GDM.
- Data collected from a perinatal database between 2008 and 2013.
- Comparison of neonatal morbidity across two three-year periods defined by guideline implementation.
Main Results:
- Gestational diabetes was diagnosed earlier post-guideline implementation.
- Increased frequency of insulin therapy was observed.
- Neonatal morbidity rose, with more cases of hypoglycemia, congenital anomalies, and smaller-than-expected newborns.
Conclusions:
- The observed increase in neonatal morbidity is associated with earlier GDM diagnosis and intensified metabolic management.
- Further investigation using national data is essential to fully comprehend these unexpected morbidity trends.
Introduction:
Gestational diabetes is one of the diseases associated with pregnancy with higher rate of complications. Despite being a transitory condition, short and long term complications related to gestational diabetes have been described. There is scientific evidence to say that good metabolic control decreases perinatal complications. In 2011, new criteria was proposed for its diagnosis, which made possible its diagnosis during the 1st trimester of pregnancy. The aim of this study is to compare neonatal morbidity in two groups of women with gestational diabetes diagnosis before and after the latest Portuguese guidelines for diabetes and pregnancy were published (February 2011).
Material And Methods:
We included all newborns born in Maternidade Bissaya Barreto whose mother, followed at our maternity between 2008 and 2013, had unifetal pregnancy complicated by diabetes. We used a perinatal database and analysed the impact of the new guidelines in perinatal morbidity over two periods of three years.
Results:
There were 774 women who met the inclusion criteria. We found that gestational diabetes was diagnosed earlier, insulin therapy was more frequent. Neonatal morbidity was increased, and there were more cases of neonatal hypoglycemia and congenital anomalies, and newborns became smaller for gestational age.
Discussion:
The increase in neonatal morbidity was associated with early diagnosis and rigorous metabolic control.
Conclusion:
To analyse national data will be fundamental to understand this unexpected increase in morbidity.