Gestational diabetes mellitus and macrosomia: municipal clinical hospital ”Gheorghe Paladi” experience

Abstract

Introduction. Gestational diabetes mellitus (GDM) is a metabolic complication during pregnancy. It is defined by the development of glucose intolerance, primarily diagnosed in pregnancy. According to literature between 15-45% of newborns of mothers with GDM are macrosomic. Fetal macrosomia (FM) is a term used for newborns with birth weight ≥ 4000 g. Aim of study. To reveal the correlation between GDM and macrosomia, to discuss the diagnosis of macrosomia and therapeutic options. Methods and materials. The retrospective study was conducted in the Obstetrics Department no.1 of Municipal Clinical Hospital ”Gheorghe Paladi” during 2021 and 83 patients were selected. Evaluated parameters were: epidemiological data, type of GDM, maternal obesity, the birth weight of the newborns, gestational age, Apgar score, type of baby delivery. Results. Mothers without GDM – 70 (84,33%), mothers with GDM – 13 (15,66%) with mean age 30,7 years. Among patients with GDM – 11 (84,61%) were with compensated form of GDM and 2 (15,38%) with decompensated form of GDM. Maternal obesity was attested in 16 (19,27%) cases, among them 5 (31,25%) delivered macrosomic newborn, 3 (18,75%) have maternal obesity associated with GDM and macrosomia and 1 (6,25%) – maternal obesity, GDM and normal weight newborn. Mothers without GDM and normal birth weight newborn – 62 (74,69%), mothers with GDM and macrosomic fetus – 9 (10,84%), mothers without GDM, but with macrosomic fetus – 8 (9,63%), mothers with GDM and normal birth weight newborn – 4 (4,81%). Newborns with birth weight <4000 g – 66 (79,51%), newborns with birth weight > 4000 g – 17 (20,48%). The average birth weight of the newborns – 3932 g. The Apgar score rates were between 0/0 – 9/9. The most common rate of the Apgar score was 8/9 (30,12%), followed by 8/8 (26,5%), 9/9 (22,89%), 7/8 (10,84), 6/7 (4,81%), 5/6 and 0/0 (1,20% each of them). The macrosomia was established in 14 cases (82%) using ultrasound. Predictive values used to estimate fetal weight were biparietal diameter, head and abdomen circumferences, femur length. GDM was primarily diagnosed at 4 nulliparous (30,76%) and 2 multiparous (15,38%).Vaginal delivery was elected in 58 cases (69,87%) and C-section 25 times (30,12%). The most frequent indications for C-section are scarred uterus, placental detachment, diabetic fetophaty, fitopelvic disproportion, dynamic distocia. Conclusion. Fetal macrosomia is a common complication among GDM patients. The correct management of glucose abnormality in the pregnancy will contribute to avoiding complications and will decrease the ratio of macrosomia. It is defined by the development of glucose intolerance, pr imarily diagnosed in pregnancy. According to literature between 15-45% of newborns of mothe rs with GDM are macrosomic. Fetal macrosomia (FM) is a term used for newborns with birth weight ≥ 4000 g. Aim of study. To reveal the correlation between GDM and macrosomia, to discuss the diagnosis of macrosomia and therapeutic options. Methods and materials. The retrospective study was conducted in the Obstetrics De partment no.1 of Municipal Clinical Hospital ”Gheorghe Paladi ” during 2021 and 83 patients were selected. Evaluated parameters were: epidemiological data, type of GDM, m aternal obesity, the birth weight of the newborns, gestational age, Apgar score, type of baby delivery. Results. Mothers without GDM – 70 (84,33%), mothers with GDM – 13 (15,66%) with mean age 30,7 years. Among patients with GDM – 11 (84,61%) were with compen sated form of GDM and 2 (15,38%) with decompensated form of GDM. Maternal obesity wa s attested in 16 (19,27%) cases, among them 5 (31,25%) delivered macrosomic newborn, 3 (18 ,75%) have maternal obesity associated with GDM and macrosomia and 1 (6,25%) – maternal obesity, GDM and normal weight newborn. Mothers without GDM and normal birth weight newborn – 62 (74,69%), mothers with GDM and macrosomic fetus – 9 (10,84%), mothers without GDM, but with macrosomic fetus – 8 (9,63%), mothers with GDM and normal birth weight newborn – 4 (4,81%). Newborns with birth weight <4000 g – 66 (79,51%), newborns with birth weight > 4000 g – 17 (20,48%). The average birth weight of the newborns – 3932 g. The Apgar score rates were between 0/0 – 9/9. The most common rate of the Apgar score was 8/9 (30,12%), followed by 8/8 (26, 5%), 9/9 (22,89%), 7/8 (10,84), 6/7 (4,81%), 5/6 and 0/0 (1,20% each of them). The macroso mia was established in 14 cases (82%) using ultrasound. Predictive values used to estim ate fetal weight were biparietal diameter, head and abdomen circumferences, femur length. GDM was primarily diagnosed at 4 nulliparous (30,76%) and 2 multiparous (15,38%).Vaginal delivery was elected in 58 cases (69,87%) and C-section 25 times (30,12%). The most frequent indi cations for C-section are scarred uterus, placental detachment, diabetic fetophaty, fitopelvic disproportion, dynamic distocia. Conclusion. Fetal macrosomia is a common complication among GDM pat ients. The correct management of glucose abnormality in the pregnancy will c ontribute to avoiding complications and will decrease the ratio of macrosomia.