Biochemical and ultrasound markers to predict fetal outcome in pregnancies complicated by gestational diabetes mellitus.

Objective To investigate the risk of perinatal outcomes based on metabolic and ultrasound markers in women with Gestational Diabetes Mellitus (GDM). Study Design Sixty women affected by GDM (34 women on diet only treatment and 26 women with on insulin treatment), were compared to 30 pregnant controls normoglycemic and comparable for age and gestational age at delivery. Neonatal plasma samples were performed to measure baby insulin levels. Multivariate analysis was performed for intrapartum complications, neonatal polycythemia, itterus and hypoglycemia; independent variables included: prepregnancy BMI, fasting glycaemia, the oral glucose tolerance test - area under the curve (OGTT-AUC), weight gain during pregnancy, ultrasound fetal abdominal thickness and need for insulin therapy. All the women recruited had a normal 24-h glucose profile. Results Neonatal insulin levels were higher in GDM than in controls (9.2 ± 2 vs 5.8 ± 1.4 microUI/ml; p<0.001) but were significantly lower in diet-treated GDM versus insulin-treated GDM (6.4 ± 2.7 vs 11.2 ± 1.6 microUI/ml; p<0.001). In multivariate analysis the factors significantly contributing to perinatal outcomes were the OGTT-AUC > 320 (OR: 2.4; 1.2-4.8 CI), fetal abdominal thickness > 95°percentile (OR: 4.2; 2.2-8.3 CI), the need of insulin therapy (OR: 6.1; 4.1-9.4 CI). Conclusion During gestational diabetes although in presence of a normal 24-h glucose profile, other parameters, achievable in a noninvasive and reproducible fashion, may predict the fetal metabolism status and the potential resulting perinatal morbidity.