Gestational diabetes: a link between ogtt, maternal-fetal outcomes and maternal glucose tolerance after childbirth

Abstract Aim The relationship among distribution of pathological values at the Oral Glucose Tolerance Test (OGTT), metabolic risk factors and pregnancy outcomes in women with Gestational Diabetes (GDM), has not been clearly identified. In this paper We aimed to retrospectively compared metabolic and therapeutic parameters, maternal-fetal outcomes and post-partum OGTTs, with respect to the number and distribution of altered values of diagnostic OGTT in pregnancy. Secondly, we assessed whether insulin therapy predictive factors were identifiable. Methods This retrospective analysis included 602 pregnant women with GDM, followed in Diabetes and Pregnancy Unit of Perugia Hospital from diagnosis to childbirth. All women were diagnosed diabetic upon 75g OGTT, according IADPSG criteria. Maternal features, pregnancy outcomes and post-partum OGTTs were assessed. Women were divided into 3 groups, according respect to distribution of diagnostic blood glucose (BG) values at OGTT: Group 1: only FPG fasting BG (OGTT0h); Group 2: 1 and/or 2h (OGTT1-2h); Group 3: both FPG fasting and 1 h and/or 2h (OGTT0+1-2h) BG. Results Pregnant women with fasting hyperglycemia impaired FPG at OGTT (Groups 1 and 3) had similar metabolic characteristics (weight, prevalence of obesity, GWG gestational weight gain, HbA1c), a greater need for insulin therapy, and a higher risk of impaired glucose tolerance IGT or IFG persistence after childbirth, as compared to Group 2. No significant differences were observed in terms of maternal and neonatal outcomes (p> 0.05), except for a greater prevalence of caesarean sections in Group 3. Conclusion The metabolic characteristics of GDM women are mirrored by OGTT values at diagnosis, but are not associated with adverse pregnancy outcomes. Intensive management and a tailored treatment of GDM improve maternal-neonatal outcomes, regardless of diagnostic values distribution and pre-gestational metabolic characteristics.