How Important Is Early Diagnosis and Intense Insulin Therapy in In Vitro Fertilization Pregnancies Complicated by Gestational Diabetes Mellitus

GDM is increased in IVF pregnancies. There is limited literature on GDM screening and management of IVF pregnancies. The aim was to investigate the impact of GDM management on the outcome of IVF pregnancies. The study was conducted with 102 singleton IVF (a), 102 GDM spontaneous conceptions (b) vs. 102 normal pregnancies (c). The group characteristics: [age: 38.2±4 vs. 34.1±3 vs. 37.4±5 years, p<0.001 (a vs. b), NS (a vs. c), <0.001 (b vs. c); BMI: 25.8±5 vs. 23±4 vs. 22.7±4 kg/m2, p<0.001 (a vs. b), <0.001 (a vs. c), NS (b vs. c); HbA1c: 5.2±0.5 vs. 5.2±0.7 vs. 4.7±0.3%, p=NS (a vs. b), <0.001 (a vs. c), <0.001 (b vs. c); FBG: 84.1±8.4 vs. 84.2±7.1 vs. 78.2±5.2 mg/dl, p=NS (a vs. b), <0.001 (a vs. c), <0.001 (b vs. c); 1-hour postprandial BG: 103.6±11 vs. 106.5±10 mg/dl, p=NS (a vs. b); week of diagnosis GDM: 21.8±5.2 vs. 23.8±6.2, p=0.03 (a vs. b); week of starting insulin: 22.8±5 vs. 24.8±5, p=0.03 (a vs. b)].The obstetric and neonatal history are: Maternal weight gain: 10.4±4 vs. 11.9±3 vs. 10.5±2kg, p=0.035 (a vs. b), p=NS (a vs. c), p=0.03 (b vs. c); week. of delivery: 36.9±2 vs. 37.4±0.7 vs. 38.1±0.8, p=0.04 (a vs. b), p<0.001 (a vs. c), p<0.001 (b vs. c); neonatal birth wt.: 2857±517 vs. 2891±341 vs. 3117±347g, p=NS (a vs. b), p<0.001 (a vs. c), p<0.001 (b vs. c); preeclampsia rate: 4.9 vs. 3.9 vs. 1.9%; Respiratory Distress Syndrome: 14.7 vs. 12 vs. 5.8%; Neonatal hypoglycemia: 17.6 vs. 14.7 vs. 3.9%, NICU admits: 14.7 vs. 15.6 vs. 5.8%, C-Section: 86.3 vs. 56.9 vs. 41.1%. Associations between characteristics and adverse outcomes were tested among the IVF group. 1-hour Postprandial BG, but not FBG nor HbA1c, was associated with maternal-fetal complications (r=0.504, p<0.001). Maternal hypoglycemia did not affect fetal outcome. Age and BMI were not correlated with the week of GDM diagnosis. The data emphasizes the importance of strict postprandial metabolic control reached by intense early insulin therapy limiting the incidence of adverse pregnancy outcomes. IVF pregnancies must be screened for GDM much earlier than 24-28 weeks. Disclosure P. Thomakos: None. O. Kepaptsoglou: None. A. Trouva: None. C. Baretto: None. D. Trouvas: None. I. Taraoune: None. A. Korantzis: None. C. Zoupas: None.