Ultraschall Med 2008; 29 - S2_OP3
DOI: 10.1055/s-2008-1080774

Quality of Treatment in Women with Gestational Diabetes in a Centre of Excellence for Diabetes and Pregnancy

E Schleußner 2, W Hunger-Battefeld 1, J Westphal 2, S Schneider 2, A Hübler 2, G Wolf 2
  • 1Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, D
  • 2Universitätsklinikum Jena, Klinik für Frauenheilkunde und Geburtshilfe, Jena, D

Objectives: To evaluate the quality of treatment in women with gestational diabetes (GDM) and irregular glucose tolerance (IGT) in an interdisciplinary centre of excellence for diabetes and pregnancy. Maternal self controle of blood glucose levels as well as fetal abdominal circumference (AC) and thickness of abdominal wall (AT) were assessed every 14 days after diagnosis for optimizing therapy and compared with perinatal parameters.

Results: 75g oral glucose tolerance test (oGTT) were performed in 227 women with suspect (irregular) GDM screening resulting in GDM 37,3% (n=85), IGT 17,6% (n=40) and normal values 44,9% (n=102, used as controls). Women with GDM/IGT already show higher HbA1c at time of diagnosis (5,5±0,6 vs. 5,0±0,4%, p<0,01 / NB 4,4 – 5,9%). Fetal AC also were greater in women with GDM/IGT (239±13 vs. 232±14mm, p<0,05). Fetal AT correlate with fasting blood glucose (r=0,290, p<0,01) and 1-hour value (r=0,343, p<0,01), but fetal AC with HbA1c (r=0,417, p<0,01), 1-hour value (r=0,280, p<0,01) and 2-hour value of oGTT (r=0,331, p<0,01).

Insulin therapy (IT) was required in 49,4% (n=42) of women with GDM and 47,5% (n=19) with IGT. Remarkably, maternal metabolic and fetal sonographic parameters were significantly higher in women requiring IT in later pregnancy.

There was no difference in perinatal morbidity between GDM/IGT and healthy pregnancies in regard to gestational age at birth (38,5±1,9 vs. 39,1±1,8 weeks), birth weight (3328±681 vs. 3392±485g), APGAR, umbilical pH, bilirubin and blood glucose values. Neonatal macrosomia appeared in 10,4% of GDM/IGT vs. 11,5% of the controls. Rate of macrosomia could be reduced by 6,4% compared to IT by optimizing only blood glucose self controls [1].

Conclusion: At time of diagnosis fetal abdominal wall thickness is a reliable predictor for a maternal glucose tolerance disorder (pathologic oGTT and HbA1c). Close-knit controls of maternal blood glucose levels are indispensible in GDM/IGT pregnancies, but dynamics in fetal AC growth give an early and important indication for insulin therapy and could improve perinatal outcome.

Literature: [1] Hunger-Dathe W, et al.: Diab Stoffw 2000; 9: 139-149