Monika Szymanska

Maternal weight gain in women with gestational diabetes mellitus.

Abstract Objective: The aim of the study was to examine the perinatal outcomes in gestational diabetes in women with body mass index (BMI)-adjusted gestational weight gain (GWG) according to the Institute of Medicine (IOM) 2009 recommendations. Material and methods: The clinic’s database was used to analyze 675 singleton GDM pregnancy outcomes. GWG for the entire pregnancy was compared to IOM recommendations and adjusted for prepregnancy BMI categories: underweight <18.5; normal 18.5–24.9; overweight 25–29.9; and obese >30. The study group was divided into three categories: below IOM limits, within IOM limits and above IOM limits. Results: Only 37% of women achieved the proper weight gain (n=256). Almost 30% of women with GDM (n=196) had an excessive weight gain. GWG above limits was associated with a significantly higher neonatal measurements and a higher rate of large-for-gestational-age neonates. In underweight and normal-prepregnancy-weight women, no relation between GWG and birth-weight percentile was noted. For the overweight and obese women, a positive significant correlation between GWG until GDM diagnosis and birth-weight percentile was noted (P=0.002), which was not present when GWG until delivery was considered. Conclusions: Limited weight gain in overweight and obese women with gestational diabetes mellitus results in favourable pregnancy outcomes.

OP08.09: Sonographic evaluation of fetal growth: importance of plasma free fatty acid concentration

Objective: Antiretroviral treatment in HIV positive pregnant women may cause a variety of morphological changes, with a heterogeneous array of manifestations. HIV protease inhibitors and the reverse transcriptase inhibitor stavudine are more consistently associated with body changes, lipid profile anomalies, risk of lipodystrophy, and increased insulin resistance. This study was to evaluate possible different fetal anthropometric characteristics by ultrasound measurement of fetal fat tissue, according to different therapeutic regimens. Methods: HIV pregnant women referred to our high risk pregnancy centre in the period between 2000 and 2005 were prospectively included in the study. Assessment of fetal fat tissue at abdominal, suprascapular, thigh, and triceps levels was carried out sonographically at 31 and 36 weeks of gestation and, directly, at birth. Results: 121 HIV positive pregnant women were enrolled with different antiretroviral treatments: no therapy in 44 cases, 40 women on nucleoside reverse transcriptase inhibitors only, 22 cases on non-nucleoside reverse transcriptase inhibitors, and 15 on protease inhibitors. Gestational age at delivery and birth weights were not significantly different between groups. Fetuses of HIV mothers subjected to antiretroviral therapy with protease inhibitors showed a nearly significant increase of abdominal and suprascapular subcutaneous tissue thickness (p = 0.07 and p = 0.09, respectively) compared to the other groups. Conclusions: A slight association between protease inhibitors and increased fetal fat is suggested by our findings, though they should be interpreted cautiously. Further researches are needed to better define the possible correlation between maternal therapy and fetal biometric modifications.