Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. It may be diagnosed using a fasting plasma glucose (FPG) early in pregnancy (eGDM) or a 75-g oral glucose tolerance test (OGTT) (late GDM). This retrospective cohort of women with GDM presents data from 1891 patients (1004 in the eGDM and 887 in the late GDM group). Student’s t-test, chi-squared or Fisher’s exact test and the Bonferroni test for post hoc analysis were used to compare the groups. Women with eGDM had higher pre-pregnancy BMI, more frequent family history of DM, more frequent history of previous GDM, and were more likely to have chronic hypertension. They were more likely to deliver by cesarean section and to present an abnormal puerperal OGTT. Even though they received earlier treatment and required insulin more frequently, there was no difference in neonatal outcomes. Diagnosing and treating GDM is necessary to reduce complications and adverse outcomes, but it is still a challenge. We believe that women with eGDM should be treated and closely monitored, even though this may increase healthcare-related costs.

The aim of this study was to evaluate the Diet Quality Index (DQI) and the Physical Activity (PA) levels associated with adequacy of gestational weight gain in pregnant women with gestational diabetes mellitus (GDM). A total of 172 pregnant women with a single fetus and a diagnosis of GDM participated. Food intake was self-reported on the food frequency questionnaire and DQI was quantified using the index validated and revised for Brazil (DQI-R). To assess PA, the Pregnancy Physical Activity Questionnaire was administered. Gestational weight gain was classified, following the criteria of the Institute of Medicine, into adequate (AWG), insufficient (IWG), or excessive (EWG) weight gain. A multinomial logistic regression analysis was performed, with level of significance <0.05. The participants were divided into 3 groups: AWG (33.1%), IWG (27.3%), and EWG (39.5%). The analysis indicated that if the pregnant women PA fell into tertile 1 or 2, then they had a greater chance of having IWG, whereas those with the lowest scores on the DQI-R, whose PA fell into tertile 2, and pregestational obesity women had the greatest chance of having EWG. This study has shown that low PA levels may contribute towards IWG. On the other hand, a low final DQI-R score, representing inadequate food habits, low PA levels, and pregestational obesity may increase the chance of EWG in patients with GDM.

This study aimed to analyze cesarean section rates among women with GDM classified according to the Robson system and to identify independent factors associated with vaginal delivery. A retrospective cohort study was conducted with pregnant women receiving care at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2012 and 2020. A total of 1508 pregnant women with GDM were included and divided into two groups based on the mode of delivery. Statistical analyses were performed to assess differences between groups and identify predictive factors for vaginal delivery using Binary logistic regression. The overall c-section rate was 65.3 %. Robson group 5 was the most representative, accounting for 39.53 % of all cesarean deliveries, with a single previous uterine scar being the primary indication (40.2 %). Spontaneous labor onset was the strongest independent predictor of vaginal delivery (OR = 8.601, 95 % CI 6.029‒12.270), whereas previous cesarean delivery (OR = 0.093, 95 % CI 0.065‒0.134), fetal distress (OR = 0.110, 95 % CI 0.071‒0.171), and multiple pregnancy (OR = 0.096, 95 % CI 0.036‒0.259) significantly reduced this likelihood. The high cesarean section rate among women with GDM, particularly in group 5, highlights the importance of previous uterine scar in determining the mode of delivery in this population. Encouraging spontaneous labor onset, provided that maternal and fetal conditions are adequately monitored, may be an effective strategy to reduce unnecessary cesarean sections in pregnancies complicated by GDM.

Gestational Diabetes Mellitus (GDM) is a common pregnancy complication and is linked to high cesarean rates, particularly in Brazil, where national data on the subject is limited. This study analyzed risk factors and primary indications for c-sections among GDM-affected pregnancies. It included a retrospective cohort of women receiving prenatal care at a tertiary hospital from January 2012 to March 2020, totaling 866 cases that met criteria: diagnosed GDM, pregnancies beyond 20 weeks, and delivery at this hospital. The cohort was divided into VAGINAL and CESAREAN groups, with statistical comparisons made between them. Of the 866 cases, 323 (37.3%) were vaginal deliveries, and 545 (62.7%) were c-sections. Primary indications for c-section included prior uterine surgeries (20.07%), iterative c-section (18.78%), fetal distress (9.76% intrapartum; 8.84% antepartum), non-cephalic presentation (7.37%), and functional dystocia (7.0%). Univariate analysis identified several factors associated with higher c-section risk, such as advanced maternal age (p<0.001), higher BMI (p=0.016), previous c-sections (p<0.001), hypertension (p=0.024), high glucose levels during pregnancy (p=0.031 for early fasting plasma glucose; p=0.002 for 1h and p<0.001 for 2h after glucose overload), nulliparity (p=0.012), multiple gestation (p<0.001), preeclampsia (p=0.012), and placenta previa (p=0.010). Conversely, spontaneous labor onset (p<0.001) and preterm labor (p=0.001) were associated with lower c-section rates. Multivariate analysis confirmed that age (OR 1,048), nulliparity (OR 2.892), previous c-section (OR 14.49), and spontaneous labor onset (OR 0.199) were independent predictors of c-section. The findings emphasize that prior uterine scars significantly increase c-section risk. In contrast, spontaneous labor onset reduces this risk by almost 80%.