Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes. Retrospective multicenter study of obese women with gestational diabetes. The assessed group was divided into three categories: women who gained below (9 kg) the 2009 Institute of Medicine recommendations. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for confounders. Only 35,1 % of obese women with gestational diabetes (n = 634) achieved the recommended gestational weight gain; 27,8 % (n = 502) gained below and 37,1 % (n = 670) above the recommendations. There was a positive correlation between gestational weight gain and neonatal birthweight (r = 0,225; p < 0,001). Gestational weight gain below recommendations was associated with lower odds for cesarean section, even adjusting for birthweight [aOR = 0,67 (0,54–0,85); p < 0,001]; lower odds for large for gestational age neonates [aOR = 0,39 (0,28–0,57); p < 0,001] and macrosomia [aOR = 0,34 (0,21–0,55); p < 0,001]. Excessive weight gain, even adjusting for birthweight, was associated with higher odds for cesarean section [aOR = 1,31 (1,07–1,61); p = 0,009], low Apgar score [aOR = 4,79 (1,19–19,21); p = 0,027], large for gestational age neonates [aOR = 2,32 (1,76–3,04); p < 0,001] and macrosomia [aOR = 2,39 (1,68–3,38); p < 0,001]. In obese women with gestational diabetes, a reduced gestational weight gain (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate weight gain. Therefore, specific recommendations should be created since gestational weight gain could be a modifiable risk factor for adverse obstetric outcomes.

Increased levels of alkaline phosphatase (ALP) should alert us to changes in the liver, kidney, bone and malignancy. However, there is a physiological increase in pregnancy up to twice the upper limit. There has been a paucity of cases reporting extreme elevations of ALP in pregnancy. This is a case of an incidental pregnancy finding of a 24-fold increase in ALP in the third trimester (2877 U/L). The patient was kept under surveillance and ALP levels were monitored during the postpartum period. Literature suggests a correlation between ALP elevation and several perinatal complications, proposing it could represent an important tool in monitoring high-risk pregnancies and underlying placental damage. We report a case with no perinatal complications and normal labor at term, with a placenta showing lesions of chronic villitis. We should not rely exclusively on an isolated, marked rise in ALP to dictate the approach in the absence of other fetomaternal considerations.

Introduction: Women with gestational diabetes mellitus (GDM) can present with hypoglycaemia during the oral glucose tolerance test (OGTT), which has been associated with adverse perinatal outcomes. Objectives: We studied whether the presence of hypoglycaemia during the OGGT (HdOGTT) was associated with adverse perinatal outcomes. Methods: Retrospective study of a national database of women diagnosed with GDM in the 24–28th week OGTT. Excluded: women with missing OGTT or the primary outcomes data. HdOGGT: any glucose value < 70 mg/dL. Primary outcomes: hypertensive disease of pregnancy, preterm delivery, caesarean section (CSA), small-for-gestational-age, large-for-gestational-age, neonatal hypoglycaemia, respiratory distress syndrome, and intensive care unit admission. Women with and without hypoglycaemia were compared. Predictors of HdOGTT and the association between HdOGTT and the primary outcomes were studied using a multivariate logistic regression analysis. Results: We analysed 7704 women, 10.7% with HdOGTT. Most of them (94.8%) presented fasting hypoglycaemia, and 3.2% had blood glucose values < 54 mg/dL. There were no differences between groups regarding the primary outcomes, except for women with HdOGTT, who had a lower rate of CSA (34.1% vs. 29.0%, p = 0.001), large-for-gestational-age newborns (9.7% vs. 13.8%, p < 0.001), and a higher rate of small-for-gestational-age newborns (11.0% vs. 6.9%, p < 0.001) than those without HdOGTT. Age, BMI, previous miscarriage, and chronic hypertension were associated with lower risk of HdOGTT. HdOGTT was only associated with increased risk of SGA [OR (95% CI): 1.25 (1.00–1.56), p = 0.047] after adjustment for confounders. Conclusions: The prevalence of HdOGTT was 10.7%. Age, BMI, previous miscarriage, and chronic hypertension were associated with lower risk of HdOGTT. HdOGTT was associated with 25% higher risk of SGA newborns.