10 min Apgar scores; placenta weight; and placental
index (PI = placenta weight/birth weight). In the cord
blood, the levels of glucose, hematocrit, hemoglobin,
bilirubin, and white and red blood cells were evaluated.
During the neonatal period, information on
hypoglycemia episodes; need for phototherapy; malformations
and infant hospital stay length was obtained.
All data were recorded on forms specifically
developed for the study.
Follow-up
All women received follow up care at the Diabetes and
Pregnancy Referral Center of Botucatu Medical School-
Unesp. Reasons for referral were previous diabetes mellitus
(type 1-DM or type 2-DM) or risk of developing
hyperglycemic disorders [20], i.e. gestational diabetes
mellitus (GDM) and mild gestational hyperglycemia
(MGH) [17, 19].
According to our center’s routine protocol [18, 19],
diabetic pregnant women (type 1-DM or type 2-DM)
were immediately managed with glycemic control, individualized
nutritional intervention, and a light to moderateintensity
exercise program (most frequently walking for
30 minutes five times a week). Insulin therapy was introduced
when necessary [21].
Pregnant women who were nondiabetic, but were
overweight or obese, were advised as to the importance
of lifestyle changes to prevent GDM and MGH, and
were promptly assigned to individualized nutritional
guidance and home walking for 30 minutes five times a
week for weight control during pregnancy. Regardless of
these preventive measures, all nondiabetic pregnant
women underwent glucose tolerance (75 g-OGTT) and
gycemic profile (GP) testing between 24 and 28 weeks of
pregnancy for confirmation or ruling out of GDM and
MGH [18–20]. Pregnant women with confirmed GDM
or MGH were treated according to the same protocol to
achieve glycemic control. Insulin therapy was introduced
when necessary. Glycemic control and management of
diabetes were evaluated by 24-h GP (fasting, pre- and
post- prandial glycemic levels) performed at 2-week intervals
until week 32, and weekly until delivery [18–20].