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Maduro C, Castro LFD, Moleiro ML, Guedes-Martins L. Pregestational Diabetes and Congenital Heart Defects. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:953-961. [PMID: 36446562 PMCID: PMC9708403 DOI: 10.1055/s-0042-1755458] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
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Affiliation(s)
- Catarina Maduro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Address for correspondence Catarina Maduro, MSc Rua Jorge de Viterbo Ferreira 228, 4050-313, PortoPortugal
| | - Luís Ferreira de Castro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal,Unidade de Investigação e Formação, Centro Materno Infantil do Norte, Porto, Portugal,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies. Eur J Pediatr 2022; 181:3111-3117. [PMID: 35751710 DOI: 10.1007/s00431-022-04536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/09/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED The purpose of the study is to investigate the effects of delayed cord clamping on bilirubin levels and phototherapy rates in neonates of diabetic mothers. This was a prospective study that enrolled pregnant women without pregnancy complications and those with diabetes. Their neonates were randomized in a 1:1 ratio to delayed cord clamping. The main outcomes were the neonatal transcutaneous bilirubin values on 2-4 days postpartum and the rate of requiring phototherapy in infants. A total of 261 pregnant women were included in the final analysis (132 women with diabetic pregnancies and 129 women with normal pregnancies). In diabetic pregnancies, neonatal bilirubin levels on the 2-4 days postpartum and phototherapy rates were significantly higher in the delayed cord clamping group than in the immediate cord clamping group (7.65 ± 1.83 vs 8.25 ± 1.96, P = 0.039; 10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.002; 11.54 ± 2.94 vs 12.83 ± 3.07 P = 0.024, 18.2% vs 6.3%, P = 0.042), while in normal pregnancies, there was no statistical difference in bilirubin values and phototherapy rates between the delayed cord clamping group and the immediate cord clamping group (P > 0.05). After receiving delayed cord clamping, bilirubin levels on the third postnatal day and the rate of requiring phototherapy in infants were higher in the diabetic pregnancy group than in the normal pregnancy group (10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.013). CONCLUSION Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. TRIAL REGISTRATION ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). WHAT IS KNOWN • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. WHAT IS NEW • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers.
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Corbett GA, Hunter S, Javaid A, McNamee E, O'Connell M, Lindow SW, Martin A. Non-diabetic fetal macrosomia: outcomes of elective delivery versus expectant management. Ir J Med Sci 2022:10.1007/s11845-022-03076-w. [PMID: 35781860 PMCID: PMC9251024 DOI: 10.1007/s11845-022-03076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Background Macrosomia in the absence of diabetes can be associated with increased neonatal and maternal morbidity. Management is usually undertaken on a case-by-case basis. Aims In order to inform local practice, this study aimed to evaluate the outcomes of the management of non-diabetic macrosomia in an Irish tertiary center. Methods A retrospective observational study was performed on all women with estimated fetal weight over 4000 g after 37 weeks’ gestation. Maternal demographics and obstetric and neonatal outcomes were recorded using the hospital information system. Women with diabetes, previous caesarean section, non-cephalic presentation, or any other complicating condition were excluded. Women were divided into two groups:Active management: Elective delivery for macrosomia—between 38 + 0 and 40 + 6 weeks’ gestation Expectant management: with induction of labour offered after 41 weeks' gestation
Results There were 397 women included, 188 with active and 209 with expectant management. There was no difference in adverse neonatal outcomes, major maternal morbidity, or mode of delivery, after exclusion of pre-labor caesarean section. Women with expectant management were more likely to go into spontaneous labor (46.9 vs 1.6%, p < 0.001) and to have a favorable cervix at the onset of induction of labor if nulliparous (86.1 vs 70.0%, p = 0.021), but have higher rates of episiotomy (28.6 vs 18.2%, p = 0.021). With active management, nulliparas with an unfavorable cervix had increased risk of anal sphincter injury (6.5 vs 0.0%, p = 0.007) and postpartum hemorrhage (59.0 vs 35.5%, p = 0.003). Conclusions Overall, there was no difference in major maternal or neonatal outcomes between management options for fetal macrosomia. However, inducing nulliparas with an unfavorable cervix for non-diabetic macrosomia was associated with obstetric anal sphincter injury and postpartum hemorrhage.
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Affiliation(s)
- Gillian A Corbett
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland.
| | - Samuel Hunter
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Amina Javaid
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Emma McNamee
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | | | - Aisling Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
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Fayehun O, Asa S. Abnormal birth weight in urban Nigeria: An examination of related factors. PLoS One 2020; 15:e0242796. [PMID: 33232372 PMCID: PMC7685448 DOI: 10.1371/journal.pone.0242796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
There is a knowledge gap on abnormal birth weight in urban Nigeria where specific community contexts can have a significant impact on a child's health. Abnormal birth weight, classified into low birth weight and high birth weight, is often associated with adverse health outcomes and a leading risk for neonatal morbidity and mortality. The study used datasets from the birth recode file of 2013 and 2018 Nigeria Demographic and Health Survey (NDHS); a weighted sample of pooled 9,244 live births by 7,951 mothers within ten years (2008-2018) in urban Nigeria. The effects of individual, healthcare utilization and community-level variables on the two abnormal birth weight categories were explored with a multinomial logistic regression models using normal birth weight as a reference group. In urban Nigeria, the overall prevalence of ABW was 18.3%; high birth weight accounted for the majority (10.7%) of infants who were outside the normal birth weight range. Predictors of LBW were community (region), child characteristic (the type of birth) and household (wealth index) while that of HBW were community (regions), child characteristics (birth intervals and sex), maternal characteristic (education) and healthcare utilization (ANC registration). LBW was significantly more prevalent in the northern part while HBW was more common in the southern part of urban Nigeria. This pattern conforms to the expected north-south dichotomy in health indicators and outcomes. These differences can be linked to suggested variation in regional exposure to urbanization in Nigeria.
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Affiliation(s)
| | - Soladoye Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ife, Nigeria
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Li Y, Wang W, Zhang D. Maternal diabetes mellitus and risk of neonatal respiratory distress syndrome: a meta-analysis. Acta Diabetol 2019; 56:729-740. [PMID: 30955125 DOI: 10.1007/s00592-019-01327-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
AIM The relationship between maternal diabetes mellitus (DM) and neonatal respiratory distress syndrome (RDS) has long been recognized, but the conclusions of this relationship were non-consistent. We conducted this meta-analysis to explore the association between maternal DM and the risk of neonatal RDS. METHODS We searched PubMed and Web of Science databases for cohort or case-control studies related to the association of maternal DM and neonatal RDS risk up to 25 August 2018. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by the use of random effect model. Meta-regression was used to explore potential sources of between-study heterogeneity. RESULTS A total of 24 studies from 23 available articles were included in this meta-analysis. For the association between maternal DM and the risk of neonatal RDS, the pooled OR was 1.47 (95% CI 1.24-1.74), especially for cohort studies (1.39, 95% CI 1.17-1.65). The pooled OR of the risk of neonatal RDS was 1.57 (95% CI 1.28-1.93) for gestational diabetes mellitus (GDM) and 2.66 (95% CI 2.06-3.44) for pre-gestational diabetes mellitus (PGDM). CONCLUSIONS This meta-analysis suggests that maternal DM, including GDM and PGDM, is linked to an increased risk of neonatal RDS.
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Affiliation(s)
- Yan Li
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Qingdao, Shandong, 266021, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Qingdao, Shandong, 266021, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, No. 38 Dengzhou Road, Qingdao, Shandong, 266021, China.
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Yan J, Su R, Zhang W, Wei Y, Wang C, Lin L, Feng H, Yang H. Epigenetic alteration of Rho guanine nucleotide exchange Factor 11 (ARHGEF11) in cord blood samples in macrosomia exposed to intrauterine hyperglycemia. J Matern Fetal Neonatal Med 2019; 34:422-431. [PMID: 30999786 DOI: 10.1080/14767058.2019.1609929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Macrosomia at birth is associated with maternal hyperglycemia and leads to subsequent susceptibility to obesity, abnormal glucose metabolism, hypertension, and dyslipidemia in offspring. Epigenetic reprogramming has been reported to be involved in the development of human diseases caused by suboptimal environmental or nutritional factors. The study was aiming to explore epigenetic mechanism influences on macrosomic infants exposed to intrauterine hyperglycemia. We performed a genome-wide analysis of DNA methylation in cord blood from macrosomic infants born to women with gestational diabetes in order to identify genes related to fetal growth or early adipose tissue development.Methods: To analyze the epigenetic patterns in umbilical cord blood in gestational diabetes mellitus (GDM), we collected umbilical cord blood from women with GDM (mean pregestational BMI of 24.4 kg/m2 and mean neonatal birth weight of 4366 g) and normal glucose-tolerant women (mean pregestational BMI of 19.8 kg/m2 and mean neonatal birth weight of 3166 g). Differentially methylated genes in the GDM group were identified using the Infinium HumanMethylation450 BeadChip array.Results: A total of 1251 genes were differentially methylated compared to the controls (p < .01). The methylation microarray data showed that two specific CpG sites (cg12604331 and cg08480098) in the gene body of ARHGEF11 were significantly hypomethylated in the cord blood in macrosomic infants. Altered DNA methylation levels of ARHGEF11 were negatively correlated with glucose levels and neonatal birth weight.Conclusions: Exposure to adverse intrauterine environments can alter fetal development, such as by affecting the nutritional status of the fetus. Such exposure can also result in significant epigenetic modifications, including DNA methylation, which could serve as a potential marker for nutrition and metabolic conditions at the neonatal stage or even in the adult.
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Affiliation(s)
- Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Rina Su
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Wanyi Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Yumei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Chen Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Li Lin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Hui Feng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
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Yan J, Yang H, Meng W, Wang Y, Shang L, Cai Z, Ji L, Wang Y, Sun Y, Liu J, Wei L, Sun Y, Zhang X, Luo T, Chen H, Yu L, Liu X, Wang Z, Chen H. Abdominal circumference profiles of macrosomic infants born to mothers with or without hyperglycemia in China. J Matern Fetal Neonatal Med 2018; 33:149-156. [PMID: 29886780 DOI: 10.1080/14767058.2018.1487941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Wenying Meng
- Department of Obstetrics and Gynecology, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Yongqing Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Lixin Shang
- Department of Obstetrics and Gynecology, General Hospital of Beijing Military Region, Beijing, China
| | - Zhenyu Cai
- Department of Obstetrics and Gynecology, Center Hospital of Aviation Industry, Beijing, China
| | - Liping Ji
- Department of Obstetrics and Gynecology, Pinggu Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Yunfeng Wang
- Department of Obstetrics and Gynecology, Beijing Hospital of Miyun City, Beijing, China
| | - Ying Sun
- Department of Obstetrics and Gynecology, Navy General Hospital, Beijing, China
| | - Jiaxiu Liu
- Department of Obstetrics and Gynecology, Beijing Daxing District Hongxing Hospital, Beijing, China
| | - Li Wei
- Department of Obstetrics and Gynecology, Beijing Chui Yang Liu Hospital, Beijing, China
| | - Yufeng Sun
- Department of Obstetrics and Gynecology, Peking University Shougang Hospital, Beijing, China
| | - Xueying Zhang
- Department of Obstetrics and Gynecology, Combined with Traditional Chinese and Western Medicine Hospital of Beijing City, Beijing, China
| | - Tianxia Luo
- Department of Obstetrics and Gynecology, Beijing No. 6 Hospital, Beijing, China
| | - Haixia Chen
- Department of Obstetrics and Gynecology, Beijing Changping Hospital of Traditional Chinese Medicine, Beijing, China
| | - Lijun Yu
- Department of Obstetrics and Gynecology, General Hospital of Jingmei Group, Beijing, China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Chengdu, China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Huerta-Saenz L, Saunders C, Yan Y. Challenging diagnosis of congenital hyperinsulinism in two infants of diabetic mothers with rare pathogenic KCNJ11 and HNF4A gene variants. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2018; 2018:5. [PMID: 30026763 PMCID: PMC6050669 DOI: 10.1186/s13633-018-0060-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/09/2018] [Indexed: 01/29/2023]
Abstract
Background Congenital hyperinsulinism (CHI) is the leading cause of persistent hypoglycemia in infants. The infants of diabetic mothers (IDMs) very frequently present with neonatal hypoglycemia associated to transient hyperinsulinism however the incidence of CHI in IDMs is unknown. Case presentation Here we report 2 cases of CHI where the diagnoses were challenged and delayed because both patients were infants of diabetic mothers (IDMs) and had concomitant complicated medical conditions. Case 1 was heterozygous for a likely pathogenic variant in KCNJ11(p.Arg206Cys), and Case 2 was heterozygous for a pathogenic HNF4A variant, (p.Arg267Cys). HNF4A-associated CHI is very rare, and this particular case had a clinical phenotype quite different from that of previously described HNF4A-CHI cases. Conclusions This case series is one of few reports in the medical literature describing two IDMs with persistent recurrent hypoglycemia secondary to CHI, and a different clinical phenotype for HNF4A-associated CHI. IDMs typically present with transient hyperinsulinism lasting no more than 2–3 days. Since being an IDM does not exclude CHI, this diagnosis should always be considered as the mostly likely etiology if neonatal hypoglycemia persists longer than the described time frame and genetic testing for CHI confirmation is highly suggested.
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Affiliation(s)
- Lina Huerta-Saenz
- 1Children's Mercy Kansas City, Division of Pediatric Endocrinology, 3101 Broadway Blvd, Kansas City, MO 64111 USA.,Children's Mercy- Wichita Specialty Clinic, Wichita, KS USA.,3University of Missouri-Kansas City, Kansas City, MO USA.,4University of Kansas Medical Center-Wichita School of Medicine, Wichita, KS USA.,7Present address: Penn State College of Medicine, Penn State Children's Hospital- Division of Pediatric Endocrinology and Diabetes, Hershey, PA USA
| | - Carol Saunders
- 3University of Missouri-Kansas City, Kansas City, MO USA.,5Center for Pediatric Genomic Medicine Children's Mercy Hospital, Kansas City, MO USA.,6Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO USA
| | - Yun Yan
- 1Children's Mercy Kansas City, Division of Pediatric Endocrinology, 3101 Broadway Blvd, Kansas City, MO 64111 USA.,Children's Mercy- Wichita Specialty Clinic, Wichita, KS USA.,3University of Missouri-Kansas City, Kansas City, MO USA
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Ladfors L, Shaat N, Wiberg N, Katasarou A, Berntorp K, Kristensen K. Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PLoS One 2017; 12:e0187917. [PMID: 29121112 PMCID: PMC5679529 DOI: 10.1371/journal.pone.0187917] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Despite improved glycemic control, the rate of large-for-gestational-age (LGA) infants remains high in pregnancies complicated by diabetes mellitus type 1 (T1DM) and type 2 (T2DM). Poor glycemic control, obesity, and excessive gestational weight gain are the main risk factors. The aim of this study was to determine the relative contribution of these risk factors for LGA in women with T1DM and T2DM, after controlling for important confounders such as age, smoking, and parity. Methods In this retrospective chart review study, we analyzed the medical files of pregnant women with T1DM and T2DM who attended the antenatal care program at Skåne University Hospital during the years 2006 to 2016. HbA1c was used as a measure of glycemic control. Maternal weight in early pregnancy and at term was registered. LGA was defined as birth weight > 2 standard deviations of the mean. Univariable and multivariable logistic regression analysis was used to calculate odds ratios (OR’s) and 95% confidence intervals (CIs) for LGA. Results Over the 11-year period, we identified 308 singleton pregnancies in 221 women with T1DM and in 87 women with T2DM. The rate of LGA was 50% in women with T1DM and 23% in women with T2DM. The multivariable regression model identified gestational weight gain and second-trimester HbA1c as risk factors for LGA in T1DM pregnancies (OR = 1.107, 95% CI: 1.044–1.17, and OR = 1.047, 95% CI: 1.015–1.080, respectively) and gestational weight gain as a risk factor in T2DM pregnancies (OR = 1.175, 95% CI: 1.048–1.318), independent of body mass index. Conclusions Gestational weight gain was associated with LGA in women with T1DM and T2DM, independent of maternal body mass index. The findings suggest that monitoring and regulation of gestational weight gain is important in the clinical care of these women, to minimize the risk of fetal overgrowth.
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Affiliation(s)
- Linnea Ladfors
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nana Wiberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anastasia Katasarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
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Prenatal, Obstetric and Perinatal Aspects in Pregnancy Associated with Pregestational Diabetes. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:376-380. [PMID: 30595906 PMCID: PMC6286449 DOI: 10.12865/chsj.43.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/21/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT: We report the case of a 37-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, diagnosed with type I diabetes mellitus from the age of three, carrier of an insulin pump for 11 years. The patient was diagnosed in adolescence with with a tumor of the ischio-rectal fossa with multiple attempts of excision which failed due to the particular situation of the tumor. Ultrasound examination diagnosed in the first trimester of pregnancy a voluminous right ovarian cystic tumor. The patient presented pregnancy-induced hypertension starting with 28 gestational weeks. Maternal-fetal and obstetric management assumed sequential ultrasound examination, ovarian tumor and maternal blood pressure drug control, and also the surgical management of the ischio-rectal tumor. Cesarean section was performed at 38 gestational weeks, outcoming with a live fetus, normal weight, good neonatal progression and favorable postoperative progression of the mother. In this case report, we emphasize the fact that in pregestational diabetes mellitus and pregnancy-induced hypertension, constant glycemic control, performed by the insulin pump, prior and during gestation, and the maternal blood pressure control are essential for maternal-fetal outcome.
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