Gestational diabetes versus obesity as risk factors for pregnancy -induced hypertensive disorders and fetal macrosomia

Abstract

Objective: To determine whether one should aim for glycaemia that is statistically ‘normal’ or for levels of glycaemia low enough to prevent macrosomia (if such a threshold exists) when glucose intolerance is detected during pregnancy Design: An audit of pregnancy outcomes in women with impaired glucose tolerance in pregnancy as compared to a local age-matched reference group with normal glucose tolerance. Results: Our study suggests that for most patients, more intensive therapy would not have been justified. Maternal smoking appeared to convey some ‘advantages’ in terms of neonatal outcomes, with reduction in large-for-gestational-age (LGA) infants and jaundice in babies of impaired glucose tolerance (IGT) mothers. Conclusions: These observations demonstrate the importance of considering risk factors other than GTT results in analysing pregnancy outcomes, while emphasizing that ‘normalisation’ of fetal size should not be our only therapeutic endpoint. Our detailed outcome review allows us to reassure patients with GDM that with current treatment protocols, they should have every expectation of a positive pregnancy outcome.