Relation of maternal birthweight with early pregnancy obesity, gestational diabetes, and offspring macrosomia

Effects of gestational diabetes mellitus on offspring: A literature review

Gestational diabetes mellitus (GDM) is a health problem that is becoming increasingly serious worldwide. It has a high incidence and strongly affects both mothers and children. In recent years, more extensive and in-depth studies have been conducted. In the present study, we systematically reviewed the effects of GDM on offspring, including the short- and long-term outcomes. Related articles were indexed in PubMed, Web of Science, Science Direct, and the Cochran Library up to June 2024. Recommendations were extracted from the identified articles and collated as themes. Many studies, which are mostly observational, have shown that GDM increases the risk of macrosomia, premature delivery or metabolic diseases, and so on, seriously affecting the outcome of pregnancy, growth and development of the child, and even the duration of the child's life. Cohort studies are the main force providing research data. The short-term effects are mainly childbirth complications. Maternal-offspring complications include a high risk of cesarean section, shoulder dystocia, and birth injury, which are often due to a large fetus. The long-term effects, including metabolic, cardiovascular, and nervous system disease are serious. Specifically, obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, neurodevelopmental and mental disease, lung and allergic disease and even risk of chromosomol abnormalities (CAs), and so on, are included. Therefore, it is important to note the negative effects of GDM on offspring. Managing pregnant women with GDM well is a top priority, especially lifestyle interventions (diet and exercise) and glucose-lowering measures in necessity.

Maternal Birth Weight From Maternal and Child Health Handbooks Predicts LGA Neonates Better Than Maternal Parameters in Pregnancy

Objective: This study is aimed at evaluating maternal birth weight, recorded in Japan's Maternal and Child Health Handbooks, as a predictor for large for gestational age (LGA) neonates compared to traditional pregnancy factors. Methods: In this retrospective study, we analyzed maternal and neonatal data from 374 singleton, full-term pregnancies at Keiju General Hospital (2017-2020). Maternal birth weight was obtained from Japan's Maternal Child Health Handbooks, and fasting plasma glucose was measured during the 75-g oral glucose tolerance test (OGTT). Logistic regression models assessed the predictive contributions of maternal birth weight and fasting plasma glucose, adjusted for maternal and pregnancy factors. Results: Among 374 patients, 9.8% of neonates were classified as LGA. This group had a higher proportion of a family history of diabetes (p = 0.04) and greater maternal height (p = 0.01), pre-pregnancy weight (p = 0.004), weight before delivery (p = 0.03), and maternal birth weight (p = 0.001) than the non-LGA group. Multivariate analysis showed that maternal birth weight remained a significant predictor of neonatal birth weight after adjusting for other risk factors (odds ratios: 2.92 for maternal birth weight between 3500 and 3999 g and 4.77 for birth weight ≥ 4000 g). Conclusion: This study suggests the potential of incorporating maternal birth weight to improve LGA risk prediction. These findings provide foundational data for further research into the integration of maternal birth weight in risk assessment models and its potential clinical applications.

Early Mid-pregnancy Blood-Based Proteins as Possible Biomarkers of Increased Infant Birth Size in Sex-Stratified Analyses

The objective of this study was to evaluate the associations of 92 maternal blood-based proteins with increased infant birth size. The study was performed at the Uppsala University Hospital, Sweden, and included 857 mother and child dyads. The mean age of the women was 30.3 years, and 53.2% were nulliparous. Blood samples were collected at mean 18 + 2 weeks' gestation, and the Olink cardiovascular II panel was used to measure 92 proteins, either known to be or suspected to be markers of cardiovascular and inflammatory disease in humans. Multiple linear regression models adjusted for maternal age, parity, pre-conception BMI, height, and smoking were performed to evaluate the association of each individual protein with infant birth size. We also performed sex-stratified analyses. Eight proteins (Matrix metalloproteinase-12 (MMP-12), Prostasin (PRSS8), Adrenomedullin (ADM), Pappalysin-1 (PAPP-A), Angiotensin-converting enzyme 2 (ACE2), Sortilin (SORT1), Lectin-like oxidized LDL receptor 1 (LOX-1), and Thrombomodulin (TM)) were associated with infant birth size after false discovery rate adjustment. In the analyses including only female infants, ten proteins (MMP-12, Growth/differentiation factor 2 (GDF-2), PRSS8, SORT1, ADM, Interleukin-1 receptor antagonist protein (IL-1ra), Leptin (LEP), ACE2, TM, and Tumor necrosis factor receptor superfamily member 11A (TNFRSF11A)) were associated with infant birth size. Two proteins (PAPP-A and PRSS8) were associated with infant birth size among male infants. Our study suggests several proteins as potential biomarkers for increased birth weight, and our findings could act as a base for future research to identify new potential markers that could be added to improve screening for large infants.

Reproductive outcomes in women and men conceived by assisted reproductive technologies in Norway: prospective registry based study

Objectives

To determine whether the perinatal outcomes of women or men who were conceived by assisted reproductive technologies are different compared with their peers who were naturally conceived.

Design

Prospective registry based study.

Setting

Medical Birth Registry of Norway.

Participants

People born in Norway between 1984 and 2002 with a registered pregnancy by the end of 2021.

Exposure

People who were conceived by assisted reproductive technologies and have had a registered pregnancy.

Main outcome measures

Comparing pregnancies and births of people who were conceived by assisted reproductive technologies and people who were naturally conceived, we assessed mean birth weight, gestational age, and placental weight by linear regression, additionally, the odds of congenital malformations, a low 5 min Apgar score (<7), transfer to a neonatal intensive care unit, delivery by caesarean section, use of assisted reproductive technologies, hypertensive disorders of pregnancy and pre-eclampsia, preterm birth, and offspring sex, by logistic regression. The occurrence of any registered pregnancy from people aged 14 years until age at the end of follow-up was assessed using Cox proportional regression for both groups.

Results

Among 1 092 151 people born in Norway from 1984 to 2002, 180 652 were registered at least once as mothers, and 137 530 as fathers. Of these, 399 men and 553 women were conceived by assisted reproductive technologies. People who were conceived by assisted reproductive technologies had little evidence of increased risk of adverse outcomes in their own pregnancies, increased use of assisted reproductive technologies, or any difference in mean birth weight, placental weight, or gestational age. The only exception was for an increased risk of the neonate having a low Apgar score at 5 min (adjusted odds ratio 1.86 (95% confidence interval 1.20 to 2.89)) among women who were conceived by assisted reproductive technologies. Odds were slightly decreased of having a boy among mothers conceived by assisted reproductive technologies (odds ratio 0.79 (95% confidence interval 0.67 to 0.93)). People conceived by assisted reproductive technologies were slightly less likely to have a registered pregnancy within the follow-up period (women, adjusted hazard ratio 0.88 (95% CI 0.81 to 0.96); men, 0.91 (0.83 to 1.01)).

Conclusions

People conceived by assisted reproductive technologies were not at increased risk of obstetric or perinatal complications when becoming parents. The proportion of people conceived by assisted reproductive technologies with a registered pregnancy was lower than among people who were naturally conceived, but a longer follow-up is required to fully assess their fertility and reproductive history.

Breast Milk and the Importance of Chrononutrition

During pregnancy the human fetus receives timed cues from the circadian rhythms of temperature, metabolites, and hormones from the mother. This influence is interrupted after parturition, the infant does not secrete melatonin and their circadian rhythms are still immature. However, evolution provided the solution to this problem. The newborn can continue receiving the mother's timed cues through breastmilk. Colostrum, transitional, and mature human milk are extraordinary complex biofluids that besides nutrients, contain an array of other non-nutritive components. Upon birth the first milk, colostrum, is rich in bioactive, immunological factors, and in complex oligosaccharides which help the proper establishment of the microbiome in the gut, which is crucial for the infants' health. Hormones, such as glucocorticoids and melatonin, transfer from the mother's plasma to milk, and then the infant is exposed to circadian cues from their mother. Also, milk components of fat, proteins, amino acids, and endogenous cannabinoids, among others, have a markedly different concentration between day and night. In the present review, we give an overview of nutritive and non-nutritive components and their daily rhythms in human milk and explore their physiological importance for the infant. Finally, we highlight some interventions with a circadian approach that emphasize the importance of circadian rhythms in the newborn for their survival, proper growth, and development. It is estimated that ~600,000 deaths/year are due to suboptimal breastfeeding. It is advisable to increase the rate of exclusive breastfeeding, during the day and night, as was established by the evolution of our species.