In Russia screening for GDM is carried out for all pregnant women without divid-ing them into groups and determining risk factors. Correction of hyperglycemia and insulin ther-apy prescription are performed at any stage of pregnancy in the absence of compensation with diet and adequate physical activity. Pregnancy with GDM is considered a high-risk group. How-ever, even at the pregravidity stage women with the highest risk for developing hyperglycemia during pregnancy should be identified in order to modify the controlled factors. Patients in this group should be warned about the importance of pregnancy planning and the risks to the mother and offspring.

AIM

To assess the risk factors for hyperglycemia in pregnancy in patients with early-onset and late-onset GDM as well as to determine the predictors of the insulin therapy pre-scription.

MATERIAL AND METHODS

The study included 82 pregnant women with newly diagnosed hyper-glycemia (not meeting the criteria for manifest diabetes mellitus (MSD)) and 82 their newborns. According to the terms of diagnosis of hyperglycemia pregnant women were divided into 2 groups: I — early-onset GSD (before 24 weeks of pregnancy) and II — late-onset GDM (after 24 weeks). Depending on the treatment received (diet or insulin therapy) the groups were divided into subgroups. A comparative analysis of risk factors for hyperglycemia during pregnancy was performed in the groups of early-onset and late-onset GDM and between pregnant women re-ceiving diet or insulin therapy as treatment. In the groups of early-onset and late-onset GDM de-livery time and birth weight were evaluated.

RESULTS

Pregnant women from group I and II did not differ statistically in age and BMI (p>0.05). When assessing the classical risk factors for hyperglycemia in pregnancy in the early-onset and late -onset GDM groups, it was found that patients with early-onset GDM were statis-tically more likely to have a history of GDM and pregestational disorders of carbohydrate me-tabolism (p<0.05). 2% (1/60) of pregnant women in the early-onset GDM group and 18% (4/22) in the late-onset GDM group did not have risk factors considered by us. Pregnant women with GDM (on insulin therapy) were statistically more likely to have a history of pregestational carbo-hydrate metabolism disorder (p=0.03) when compared with pregnant women receiving only diet. Delivery time and the percentile of birth weight did not differ statistically in the groups of early-onset and late-onset GDM (p>0.05).

CONCLUSION

Conducting a continuous screening of GDM without dividing into risk groups and identifying risk factors is very important for detecting hyperglycemia both in the early stages and throughout pregnancy. Timely dietary administration, self-glycemic control, and insulin therapy are essential to the health of the offspring. Women planning a pregnancy with impaired fasting glycemia, a history of impaired glucose tolerance, a history of GDM should be warned about the risk of developing early hyperglycemia during pregnancy with a possible transfer to insulin therapy and the risk of GDM recurrence. Such patients from an early stage should be under the super-vision of an obstetrician-gynecologist, endocrinologist, and from the 6-7th gestational week of should be directed to determine the fasting level of glucose in venous plasma with subsequent observation according to the Russian National Consensus «Gestational Diabetes Mellitus: diagnosis, treatment and postpartum follow-up» (No. 15-4/10/2-9478, 2013). Timely diagnosed hyperglycemia and treatment aimed at achieving normoglycemia lead to a decrease in the incidence of obstetric and perinatal complications.