SUN-631 New Therapeutic Targets for Gestational Diabetes Control Impact Insulinization, Birth Weight and Neonatal Morbidities

Uncontrolled Gestational Diabetes (GD) is associated with fetal macrosomia and neonatal morbidities. New therapeutic targets for glycemic control in GD were implemented in Portugal, in January 2017 (old targets: fasting blood glucose <92 mg/dL, 1 hour after a meal <120 mg/dL; new targets: fasting blood glucose <95 mg/dL, 1 hour after a meal <140 mg/dL). (1) Our goal was to analyze the impact that these new therapeutic targets had in the insulinization degree of the pregnant woman and in the birth weight and morbidities of the newborn. We did a retrospective study with 477 pregnant women with GD followed in a specialized appointment of our Hospital, between January 2016 and December 2017. The data collected were: age, body mass index (BMI), previous abortions, previous parity, previous pregnancies, diagnostic fasting blood glucose, diagnostic oral glucose tolerance test, insulin therapy, year of birth, birth weight, neonatal morbidities and necessity of admission in the Neonatal Care Unit (NCU). We assisted 219 pregnant women in 2016 and in the following year 248, with no differences between both groups in what concerns age, BMI, parity, abortions, previous pregnancies and glycemic values at diagnosis. In 2016, 119 pregnant women were treated with insulin, while in 2017 we initiated insulin in 84 women (p<0.001). There was a strong correlation between the year and degree of insulinization (p<0.01; Lambda 0.13, p=0.03; Phi=-0.21; p<0.01). There was no difference between the median of the birth weight in 2016 and 2017 (3200 gr (P25: 2872.50; P75: 3500.00) and 3220 gr (P25: 2970.00; P75: 3525.00), respectively (p=0.34)). According to Fenton curves, 81.5% from the 2016 newborns were classified as appropriate for gestational age, 14.4% as small for gestational age and 4.2% as large for gestational age (p<0.001). In 2017, 87.0% were appropriate, 9.0% small and 4.1% large (p<0.001). This differences strongly correlate with the degree of insulinization (p=0.046; V de Cramer=0.13, p=0.03; Lambda=0.03, p=0.04). In 2016, 26.0% of the newborns had neonatal morbidities (52.7% had hypoglycemia, 28.0% had hyperbilirrubinemia, 7.0% had respiratory distress syndrome), 24.6% of them with admission in the NCU. In 2017, 19.8% of the newborns had neonatal morbidities (46.9% with hypoglycemia, 26.5% with hyperbilirrubinemia, 4.1% with respiratory distress syndrome), 34.7% of them with admission in the NCU. All of these differences were statically significant (p<0.001). In conclusion, these new targets for glycemic control in GD led to less insulinization of the pregnant women, no differences between weight at birth of the newborns, a different distribution of the weight of birth according to Fenton curves (more newborns classified as appropriate for gestational age and less classified as small or large) and a reduction of neonatal morbidities. Ref: (1) Almeida et al. Revista Portuguesa de Diabetes. 2017; 12 (1): 24-38