de Souza Pollyana Carvalho, da Silva Amanda Gabriela Araújo, Santos Cristina Maria de Araújo Medeiros, Santiago Luciana Araújo Cartaxo da Costa, Araújo Maria Elionês de Oliveira, de Lima Isabelle Lorena Barbosa, Ribeiro Karla Danielly da Silva
Universidade Federal do Rio Grande do Norte, Maternidade Escola Januário Cicco, Programa de Residência Médica, Natal, RN, Brazil.
Universidade Federal do Rio Grande do Norte, Hospital Universitário Ana Bezerra, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte, Maternidade Escola Januário Cicco, Programa de Pós-Graduação de Ciências Aplicadas à Saúde da Mulher, Natal, RN, Brazil.
J Pediatr (Rio J). 2025 Mar-Apr;101(2):179-186. doi: 10.1016/j.jped.2024.03.016. Epub 2024 Sep 30.
To compare the perinatal outcomes of women with Gestational Diabetes Mellitus (GDM), between pregnant treated only with lifestyle changes and pregnant treated with insulin and lifestyle changes.
Prospective cohort study with follow-up of 64 women with GDM during the prenatal care and postpartum period until hospital discharge, divided into a control group (43) and an insulin group (21), with collection of sociodemographic, clinical, glycemic control and perinatal outcome data. Fetal macrosomia (≥ 4 Kg), or large-for-gestational-age newborns were considered the primary outcome of the research.
Pre-pregnancy BMI (31.2 ± 3.9 versus 28.8 ± 5.5), diastolic blood pressure (75 ± 8.7 versus 69 ± 6.9) and postprandial blood glucose (136.6 versus 115.4) were higher in the insulin group, respectively. The control group had an average birth weight of 3058 g and an incidence of preterm birth of 11.6 %, while the insulin group had an average birth weight of 3203 g, with an incidence of preterm birth of 4.8 %. The majority of newborns had an adequate weight for their gestational age. Even all participants met glycemic goals, in the insulin group the Apgar score at the 5th minute and exclusive breastfeeding was lower, had 100 % of resuscitation cases, and a longer inpatient period.
These data reinforce that even during prenatal care with lifestyle changes, newborns of women with GDM treated with insulin had worse outcomes, including clinical complications and less exclusive breastfeeding. It is important in prenatal care to identify neonates with risk for prevention and health promotion measures.
比较仅通过生活方式改变治疗的妊娠期糖尿病（GDM）孕妇与采用胰岛素和生活方式改变治疗的GDM孕妇的围产期结局。
对64例GDM孕妇进行前瞻性队列研究，在产前护理和产后期间进行随访直至出院，分为对照组（43例）和胰岛素组（21例），收集社会人口统计学、临床、血糖控制和围产期结局数据。巨大儿（≥4千克）或大于胎龄儿被视为该研究的主要结局。
胰岛素组的孕前体重指数（31.2±3.9对28.8±5.5）、舒张压（75±8.7对69±6.9）和餐后血糖（136.6对115.4）分别更高。对照组的平均出生体重为3058克，早产发生率为11.6%，而胰岛素组的平均出生体重为3203克，早产发生率为4.8%。大多数新生儿的体重与其胎龄相符。即使所有参与者均达到血糖目标，但胰岛素组在第5分钟时的阿氏评分和纯母乳喂养率较低，复苏病例占100%，住院时间更长。
这些数据进一步表明，即使在通过生活方式改变进行产前护理期间，接受胰岛素治疗的GDM孕妇的新生儿结局更差，包括临床并发症和纯母乳喂养较少。在产前护理中识别有风险的新生儿以采取预防和健康促进措施很重要。
