OP-08 The effect of maternal metabolic factors and lipid profile on birth weight in pregnants with gestational diabetes and normal glucose tolerance

Objective

Gestational diabetes is correlated with metabolic disorders like, obesity, insulin resistance, hyperlipidemia, and hypertension.[1] The physiological changes providing the accumulation of maternal serum content towards the fetus to support its growth mimick the metabolic syndrome, and they are exaggerated in women with gestational diabetes.[2] This study aimed to investigate the impact of maternal metabolic syndrome parameters and lipid profiles on intrauterine fetal development in pregnancies with gestational diabetes and with normal glucose tolerance. The second aim was to compare the metabolic profiles of pregnant women with GDM and those with normal glucose tolerance.

Methods

Pregnant women who applied for an oral glucose tolerance test were examined for metabolic syndrome between 24th-28th weeks. The group diagnosed with gestational diabetes and those with normal glucose tolerance were compared in terms of obesity, hypertension, serum lipid profile, and neonatal birth weight. Hypertriglyceridemic and normotriglyceridemic patients were compared regarding maternal metabolic syndrome criteria and neonatal birthweight.

Results

Diabetic pregnants had significantly higher body mass index and triglyceride levels and lower high-density lipoprotein levels than non-diabetics. The hypertension rate was also higher; however, it was not statistically significant(Table 1). Those with hypertriglyceridemia had higher body mass index, HbA1c level, and neonatal birth weight in the diabetic group (Table 2). Triglyceride level did not impact neonatal birthweight in non-diabetic patients. Obesity, high HbA1c and triglyceride levels, and low high-density lipoprotein levels were the parameters leading to fetal macrosomia in gestational diabetes.

Discussion

The extension of the changes in maternal lipid and carbohydrate metabolism to support fetal growth differs depending on the gestational diabetes status. The studies in the literature report that despite adequate glycemic control proved by standardized measures like fasting, 1st-hour, and 2nd-hour blood glucose levels or HbA1c level, macrosomia rates are higher in pregnant women with gestational diabetes. This raises the question of whether there are other factors leading to macrosomia in insulin-resistant patients.

Conclusion

GDM is a pathology related to several metabolic disorders, such as obesity, insulin resistance, hyperlipidemia, and hypertension. All of these disorders are components of metabolic syndrome interacting with each other, changing the intrauterine environment and leading to fetal macrosomia.  The prevention of obesity in reproductive age, the prevention of excessive weight gain throughout pregnancy, and more liberal use of antidiabetic agents to avoid the lipolytic effects of insulin resistance in gestational diabetes, instead of insisting on long-term dietary restrictions, may decrease the macrosomia risk.

Keywords

Gestational diabetes, insulin resistance, macrosomia, metabolic disorder

1. Negrato CA, Jovanovic L, Tambascia MA, Geloneze B, Dias A, Calderon Ide M, et al. Association between insulin resistance, glucose intolerance, and hypertension in pregnancy. Metab Syndr Relat Disord. 2009;7(1):53-9.
2. Lesser KB, Carpenter MW. Metabolic changes associated with normal pregnancy and pregnancy complicated by diabetes mellitus. Semin Perinatol. 1994;18(5):399-406.
3.  Retnakaran R, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, et al. Effect of maternal weight, adipokines, glucose intolerance and lipids on infant birth weight among women without gestational diabetes mellitus. Cmaj. 2012;184(12):1353-60.

	File/Dsecription
	Table 1
	Table 2