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Das P, Saha S, Das T, Das P, Roy TB. Confluence of Newborn's sex and their Mother's characteristics resulting in fetal macrosomia among Indian neonates. Pediatr Neonatol 2024:S1875-9572(24)00050-0. [PMID: 38692947 DOI: 10.1016/j.pedneo.2023.11.008] [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: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND A newborn's birth weight ≥4000 g is defined as fetal macrosomia, which is recognized as a reproductive and serious child health concern. OBJECTIVES Our study aims to reveal existence of any connection between maternal factors and newborn sex in giving birth to newborn ≥4000 g in an Indian context. METHODS Data were drawn from the fifth round of National Family Health Survey (NFHS-5). A cross-sectional observational study was carried out with a total of 152,827 children born to women in reproductive age group (15-49) who had most recent live birth in the five years preceding the survey. Descriptive analyses, cross-tabulation, test of association and multivariate logistic regression analyses were performed. RESULTS In India, the prevalence of macrosomia was found in 3.8% of the total study participants. Considering newborn characteristics, fetal macrosomia was more prevalent among male neonates than female (AOR: 0.730; 95% CI: 0.687-0.775). Regarding maternal characteristics, overweight (AOR: 1.468; 95% CI: 2.042-2.559) and obese (AOR: 2.764; 95% CI: 2.394-3.192) motherswith gestational diabetes (AOR: 1.731, 95% CI: 1.385-2.164) and hypertension (AOR: 1.288, 95% CI: 1.116-1.488) were more likely to giving birth of macrosomic babies. Multiparous mothers (AOR: 1.207, 95% CI: 1.128-1.293) and women who did not undergo proper antenatal care (ANC) follow up had also greater risk of developing fetal macrosomia. Muslim women (AOR: 1.223, 95% CI: 1.119-1.338), and women belonging to a tribe (AOR: 1.476, 95% CI: 0.922-2.361) were significantly associated with the risk of having newborn ≥4000 g. CONCLUSION Emphasis should be given on counseling for mothers for desired weight management before and during pregnancy, gestational diabetes and hypertension screening, physical activity during pregnancy, adequate ANC follow up and balanced dietary intake among pregnant women.
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Affiliation(s)
- Priya Das
- Department of Geography, University of Gour Banga, Malda, West Bengal, India, 732101
| | - Subhadeep Saha
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India, 733134
| | - Tanu Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India, 733134
| | - Partha Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India, 733134
| | - Tamal Basu Roy
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, India, 733134.
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Minami M, J-P NA, Noguchi S, Eitoku M, Muchanga SMJ, Mitsuda N, Komori K, Yasumitsu-Lovell K, Maeda N, Fujieda M, Suganuma N. Gestational weight gain mediates the effects of energy intake on birth weight among singleton pregnancies in the Japan Environment and Children's Study. BMC Pregnancy Childbirth 2022; 22:568. [PMID: 35842582 PMCID: PMC9287949 DOI: 10.1186/s12884-022-04898-3] [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: 01/24/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Extra energy intake is commonly recommended for pregnant women to support fetal growth. However, relevant data regarding variations in energy intake and expenditure, body mass index and gestational weight gain (GWG) are frequently not considered. This study aimed to investigate how energy intake during pregnancy and gestational weight gain (GWG) are associated with birth weight. Methods Early pregnant women were recruited into a Japanese nationwide prospective birth cohort study between 2011 and 2014. We analysed data of 89,817 mother-child pairs of live-born non-anomalous singletons after excluding births before 28 weeks or after 42 weeks. Energy intake during pregnancy was estimated from self-administered food frequency questionnaires (FFQ) and was stratified into low, medium, and high. Participants completed the FFQ in mid-pregnancy (mean 27.9 weeks) by recalling food consumption at the beginning of pregnancy. Effects of energy intake on birth weight and mediation by GWG were estimated using the Karlson–Holm–Breen method; the method separates the impact of confounding in the comparison of conditional and unconditional parameter estimates in nonlinear probability models. Relative risks and risk differences for abnormal birth size were calculated. Results Mean daily energy intake, GWG, and birth weight were 1682.1 (533.6) kcal, 10.3 (4.0) kg, and 3032.3 (401.4) g, respectively. 6767 and 9010 women had small-for-gestational-age and large-for-gestational-age infants, respectively. Relative to low energy intake, moderate and high intakes increased adjusted birth weights by 13 g and 24 g, respectively: 58 and 69% of these effects, respectively, were mediated by GWG. Compared with the moderate energy intake group, the low energy intake group had seven more women per 1000 women with a small-for-gestational-age birth, whereas the high energy intake group had eight more women per 1000 women with a large-for-gestational-age birth. Conclusion GWG mediates the effect of energy intake on birth weight. All pregnant women should be given adequate nutritional guidance for optimal GWG and fetal growth.
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Affiliation(s)
- Marina Minami
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Naw Awn J-P
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Shuhei Noguchi
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
| | - Sifa Marie Joelle Muchanga
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Kaori Komori
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Kahoko Yasumitsu-Lovell
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Nagamasa Maeda
- Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
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Huang R, Dong Y, Levy E, Julien P, Marc I, He H, Xu YJ, Wei SQ, Fraser WD, Luo ZC. Large-for-Gestational-Age, Leptin, and Adiponectin in Infancy. J Clin Endocrinol Metab 2022; 107:e688-e697. [PMID: 34477199 DOI: 10.1210/clinem/dgab642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Fetal overgrowth "programs" an elevated risk of obesity and type 2 diabetes in adulthood. Plausibly, adipokines may be involved in programming metabolic health. OBJECTIVE This work aimed to evaluate whether large-for-gestational-age (LGA), an indicator of fetal overgrowth, is associated with altered circulating leptin and adiponectin levels in infancy, and assess the determinants. METHODS In the Canadian 3D birth cohort, we studied 70 LGA (birth weight > 90th percentile) and 140 optimal-for-gestational-age (OGA, 25th-75th percentiles) infants matched by maternal ethnicity, smoking, and gestational age at delivery. The primary outcomes were fasting leptin, and total and high-molecular-weight (HMW) adiponectin concentrations at age 2 years. RESULTS LGA infants had higher body mass index (BMI) than OGA infants. However, there were no significant differences in leptin, and total and HMW adiponectin concentrations. Leptin concentrations were positively associated with female sex, weight (z score) gain 0 to 24 months, current BMI, and the sum of triceps and subscapular skinfold thickness, and negatively associated with maternal age and White ethnicity. Female sex was associated with lower total and HMW adiponectin concentrations. Weight (z score) gain 0 to 24 months and current BMI were positively correlated with total and HMW adiponectin concentrations in LGA infants only. CONCLUSION This study is the first to demonstrate that LGA does not matter for circulating leptin and adiponectin concentrations in infancy, and there may be LGA-specific positive associations between weight gain or current BMI and adiponectin concentrations in infancy, suggesting dysfunction in establishing the adiposity-adiponectin negative feedback loop in LGA individuals.
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Affiliation(s)
- Rong Huang
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, H3T 1C5, Canada
| | - Yu Dong
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Emile Levy
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, H3T 1C5, Canada
| | - Pierre Julien
- CHU de Quebec-Laval University Research Center, Laval University, Quebec City G1V 4G2, Canada
| | - Isabelle Marc
- CHU de Quebec-Laval University Research Center, Laval University, Quebec City G1V 4G2, Canada
| | - Hua He
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Ya-Jie Xu
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Shu-Qin Wei
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, H3T 1C5, Canada
| | - William D Fraser
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke J1H 5N4, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, H3T 1C5, Canada
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Bizerea-Moga TO, Pitulice L, Pantea CL, Olah O, Marginean O, Moga TV. Extreme Birth Weight and Metabolic Syndrome in Children. Nutrients 2022; 14:nu14010204. [PMID: 35011079 PMCID: PMC8746946 DOI: 10.3390/nu14010204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 01/19/2023] Open
Abstract
Small and large birth weights (BWs) for gestational age (GA) represent extremes, but the correlation between extreme BW and metabolic syndrome (MetS) has not been fully elucidated. In this study, we examined this correlation in obese children based on changes in their metabolic profile from childhood to adolescence. A retrospective observational study was performed on 535 obese patients aged 0–18 years in the Clinical and Emergency Hospital for Children “Louis Turcanu” in Timisoara, Romania, based on clinical and biological data from January 2015 to December 2019. We emphasized the links between extreme BW and obesity, extreme BW and cardiometabolic risk, obesity and cardiometabolic risk, and extreme BW, obesity and MetS. Children born large for gestational age (LGA) predominated over those born small for gestational age (SGA). Our findings showed that BW has an independent effect on triglycerides and insulin resistance, whereas obesity had a direct influence on hypertension, impaired glucose metabolism and hypertriglyceridemia. The influences of BW and obesity on the development of MetS and its components are difficult to separate; therefore, large prospective studies in normal-weight patients are needed.
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Affiliation(s)
- Teofana Otilia Bizerea-Moga
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq no. 2, 300041 Timișoara, Romania; (T.O.B.-M.); (O.M.)
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.L.P.); (O.O.)
| | - Laura Pitulice
- Department of Biology-Chemistry, West University of Timişoara, Pestallozi 16, 300115 Timişoara, Romania
- Laboratory of Advanced Researches in Environmental Protection, Oituz 4, 300086 Timişoara, Romania
- Correspondence: ; Tel.: +40-744-517-275
| | - Cristina Loredana Pantea
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.L.P.); (O.O.)
| | - Orsolya Olah
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.L.P.); (O.O.)
- Department VIII of Neuroscience—Psychology Discipline, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq no. 2, 300041 Timișoara, Romania
| | - Otilia Marginean
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq no. 2, 300041 Timișoara, Romania; (T.O.B.-M.); (O.M.)
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.L.P.); (O.O.)
| | - Tudor Voicu Moga
- Department VII of Internal Medicine—Gastroenterology Discipline, Advanced Regional Research Center in Gastroenterology and Hepatology, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq no. 2, 300041 Timișoara, Romania;
- Gastroenterology and Hepatology Clinic, ‘Pius Brînzeu’ County Emergency Clinical Hospital, Liviu Rebreanu 156, 300723 Timișoara, Romania
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5
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The Role of Metformin in Treating Preeclampsia. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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White A, Stremming J, Boehmer BH, Chang EI, Jonker SS, Wesolowski SR, Brown LD, Rozance PJ. Reduced glucose-stimulated insulin secretion following a 1-wk IGF-1 infusion in late gestation fetal sheep is due to an intrinsic islet defect. Am J Physiol Endocrinol Metab 2021; 320:E1138-E1147. [PMID: 33938236 PMCID: PMC8285601 DOI: 10.1152/ajpendo.00623.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Insulin and insulin-like growth factor-1 (IGF-1) are fetal hormones critical to establishing normal fetal growth. Experimentally elevated IGF-1 concentrations during late gestation increase fetal weight but lower fetal plasma insulin concentrations. We therefore hypothesized that infusion of an IGF-1 analog for 1 wk into late gestation fetal sheep would attenuate fetal glucose-stimulated insulin secretion (GSIS) and insulin secretion in islets isolated from these fetuses. Late gestation fetal sheep received infusions with IGF-1 LR3 (IGF-1, n = 8), an analog of IGF-1 with low affinity for the IGF binding proteins and high affinity for the IGF-1 receptor, or vehicle control (CON, n = 9). Fetal GSIS was measured with a hyperglycemic clamp (IGF-1, n = 8; CON, n = 7). Fetal islets were isolated, and insulin secretion was assayed in static incubations (IGF-1, n = 8; CON, n = 7). Plasma insulin and glucose concentrations in IGF-1 fetuses were lower compared with CON (P = 0.0135 and P = 0.0012, respectively). During the GSIS study, IGF-1 fetuses had lower insulin secretion compared with CON (P = 0.0453). In vitro, glucose-stimulated insulin secretion remained lower in islets isolated from IGF-1 fetuses (P = 0.0447). In summary, IGF-1 LR3 infusion for 1 wk into fetal sheep lowers insulin concentrations and reduces fetal GSIS. Impaired insulin secretion persists in isolated fetal islets indicating an intrinsic islet defect in insulin release when exposed to IGF-1 LR3 infusion for 1 wk. We speculate this alteration in the insulin/IGF-1 axis contributes to the long-term reduction in β-cell function in neonates born with elevated IGF-1 concentrations following pregnancies complicated by diabetes or other conditions associated with fetal overgrowth.NEW & NOTEWORTHY After a 1-wk infusion of IGF-1 LR3, late gestation fetal sheep had lower plasma insulin and glucose concentrations, reduced fetal glucose-stimulated insulin secretion, and decreased fractional insulin secretion from isolated fetal islets without differences in pancreatic insulin content.
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Affiliation(s)
- Alicia White
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jane Stremming
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brit H Boehmer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eileen I Chang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sonnet S Jonker
- Knight Cardiovascular Institute, Center for Developmental Health, Oregon Health & Science University, Portland, Oregon
| | - Stephanie R Wesolowski
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura D Brown
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul J Rozance
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Affiliation(s)
- Dorit Koren
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
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Biratu AK, Wakgari N, Jikamo B. Magnitude of fetal macrosomia and its associated factors at public health institutions of Hawassa city, southern Ethiopia. BMC Res Notes 2018; 11:888. [PMID: 30545390 PMCID: PMC6293502 DOI: 10.1186/s13104-018-4005-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives This study aimed to determine the magnitude of fetal macrosomia and associated factors at public health institutions of Hawassa city, southern Ethiopia. Results In this study, the magnitude of fetal macrosomia found to be 11.86%. Being a male (AOR = 2.2, 95% CI 1.1–4.2), ≥ 37 weeks gestational age (AOR = 6.0, 95% CI 3.1–11.1) and having previous history of fetal macrosomia (AOR = 14.5, 95% CI 7.2–29.2) had a higher odds of fetal macrosomia. Moreover, the magnitude of fetal macrosomia is found be in the global range. Sex of the child, previous history of fetal macrosomia and gestational age were significantly associated with fetal macrosomia. The obstetric care providers should assess all pregnant women for history of fetal macrosomia which would help them to be prepared for the managements of maternal and perinatal complications. Electronic supplementary material The online version of this article (10.1186/s13104-018-4005-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andargachew Kassa Biratu
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Birhanu Jikamo
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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9
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Dong Y, Luo ZC, Nuyt AM, Audibert F, Wei SQ, Abenhaim HA, Bujold E, Julien P, Huang H, Levy E, Fraser WD. Large-for-Gestational-Age May Be Associated With Lower Fetal Insulin Sensitivity and β-Cell Function Linked to Leptin. J Clin Endocrinol Metab 2018; 103:3837-3844. [PMID: 30032199 PMCID: PMC6179169 DOI: 10.1210/jc.2018-00917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/13/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Fetal overgrowth is associated with increased risk for type 2 diabetes in adulthood. It is unclear whether there are alterations in insulin sensitivity and β-cell function in early life. OBJECTIVE To determine whether large-for-gestational-age (LGA) (birth weight > 90th percentile), an indicator of fetal overgrowth, is associated with altered fetal insulin sensitivity and β-cell function. STUDY DESIGN, POPULATION, AND OUTCOMES In the Design, Development, and Discover birth cohort in Canada, we studied 106 pairs of LGA and optimal-for-gestational-age (OGA; birth weight, 25th to 75th percentiles) infants matched by maternal ethnicity, smoking status, and gestational age. Cord plasma glucose-to-insulin ratio was used as an indicator of fetal insulin sensitivity, and proinsulin-to-insulin ratio was used as an indicator of β-cell function. Cord plasma leptin and high-molecular-weight (HMW) adiponectin concentrations were measured. RESULTS Comparisons of infants who were born LGA vs OGA, adjusted for maternal and newborn characteristics, showed that cord blood insulin, proinsulin, and leptin concentrations were significantly higher, whereas HWM adiponectin concentrations were similar. Glucose-to-insulin ratios were significantly lower (15.4 ± 28.1 vs 22.0 ± 24.9; P = 0.004), and proinsulin-to-insulin ratios significantly higher (0.73 ± 0.82 vs 0.60 ± 0.78; P = 0.005) in LGA vs OGA newborns, indicating lower insulin sensitivity and β-cell function in LGA newborns. These significant differences were almost unchanged after further adjustment for cord blood adiponectin levels but disappeared upon additional adjustment for cord blood leptin levels. CONCLUSIONS This study demonstrates that LGA may be associated with decreases in both fetal insulin sensitivity and β-cell function. The alterations appear to be linked to elevated leptin levels.
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Affiliation(s)
- Yu Dong
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zhong-Cheng Luo
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Correspondence and Reprint Requests: Zhong-Cheng Luo, MD, PhD, Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 700 University Avenue, Room 8-936, Toronto, Ontario M5G 1X5, Canada. E-mail: , ; or William D. Fraser, MD, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Room 2975, Sherbrooke, Quebec J1H 5N4, Canada. E-mail:
| | - Anne Monique Nuyt
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Francois Audibert
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Shu-Qin Wei
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Haim A Abenhaim
- Jewish General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Emmanuel Bujold
- CHU-Quebec Laval University Research Center, Laval University, Quebec City, Quebec, Canada
| | - Pierre Julien
- CHU-Quebec Laval University Research Center, Laval University, Quebec City, Quebec, Canada
| | - Hong Huang
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Pediatric Nephrology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Emile Levy
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
| | - William D Fraser
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Correspondence and Reprint Requests: Zhong-Cheng Luo, MD, PhD, Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 700 University Avenue, Room 8-936, Toronto, Ontario M5G 1X5, Canada. E-mail: , ; or William D. Fraser, MD, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Room 2975, Sherbrooke, Quebec J1H 5N4, Canada. E-mail:
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Hyer S, Balani J, Shehata H. Metformin in Pregnancy: Mechanisms and Clinical Applications. Int J Mol Sci 2018; 19:E1954. [PMID: 29973490 PMCID: PMC6073429 DOI: 10.3390/ijms19071954] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/12/2018] [Accepted: 06/29/2018] [Indexed: 01/27/2023] Open
Abstract
Metformin use in pregnancy is increasing worldwide as randomised controlled trial (RCT) evidence is emerging demonstrating its safety and efficacy. The Metformin in Gestational Diabetes (MiG) RCT changed practice in many countries demonstrating that metformin had similar pregnancy outcomes to insulin therapy with less maternal weight gain and a high degree of patient acceptability. A multicentre RCT is currently assessing the addition of metformin to insulin in pregnant women with type 2 diabetes. RCT evidence is also available for the use of metformin in pregnancy for women with Polycystic Ovarian Syndrome and for nondiabetic women with obesity. No evidence of an increase in congenital malformations or miscarriages has been observed even when metformin is started before pregnancy and continued to term. Body composition and metabolic outcomes at two, seven, and nine years have now been reported for the offspring of mothers treated in the MiG study. In this review, we will briefly discuss the action of metformin and then consider the evidence from the key clinical trials.
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Affiliation(s)
- Steve Hyer
- Department of Endocrinology, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
| | - Jyoti Balani
- Department of Endocrinology, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
| | - Hassan Shehata
- Department of Maternal Medicine, Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, Surrey, UK.
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Maternal early pregnancy obesity and related pregnancy and pre-pregnancy disorders: associations with child developmental milestones in the prospective PREDO Study. Int J Obes (Lond) 2018; 42:995-1007. [PMID: 29686379 DOI: 10.1038/s41366-018-0061-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Previous studies have linked maternal pre-pregnancy obesity (BMI ≥30 kg/m2) with suboptimal neurodevelopment in her offspring; however, the literature is not entirely consistent. Whether these effects are muddled by maternal self-reports of pre-pregnancy weight and height, or are driven or amplified by the well often comorbid hypertensive and diabetic pregnancy and pre-pregnancy disorders, remains unclear. We examined whether maternal early pregnancy obesity is associated with developmental delay in her offspring, and if the associations are driven or amplified by diabetic and hypertensive pregnancy and pre-pregnancy disorders. SUBJECTS/METHODS A total of 2504 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Data on maternal early pregnancy obesity, pre-pregnancy, and gestational hypertension, pre-eclampsia, type 1 and gestational diabetes were derived from the Finnish Medical Birth Register. At the child's mean age of 42.1 (SD = 8.2) months the mothers completed the Ages and Stages Questionnaire (ASQ) Third edition for developmental milestones. RESULTS Children of obese mothers had 1.81-2.74 (p-values <0.02) higher odds of failing to meet the development that is typical for a child's age (developmental domain score ≤-2SD below the child's age) on the communication, fine and gross motor, problem solving and personal/social skills and children of overweight mothers had 2.14 (p = 0.002) higher odds of failing to meet the development that is typical for the child's age on communication skills. Odds of developmental delay were also higher for children of mothers with pre-eclampsia and gestational diabetes. The associations were robust to covariates and confounders, the effects of overweight/obesity and pre-eclampsia were not driven by the other disorders, and overweight/obesity and hypertensive and diabetic disorders did not show additive effects. CONCLUSIONS Maternal early pregnancy overweight, obesity, and pre-eclampsia are independently associated with neurodevelopmental delay in her offspring. Further studies unraveling the underlying mechanisms are warranted.
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Lei X, Zhao D, Huang L, Luo Z, Zhang J, Yu X, Zhang Y. Childhood Health Outcomes in Term, Large-for-Gestational-Age Babies With Different Postnatal Growth Patterns. Am J Epidemiol 2018; 187:507-514. [PMID: 28992219 DOI: 10.1093/aje/kwx271] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/28/2017] [Indexed: 01/03/2023] Open
Abstract
Large-for-gestational-age (LGA) babies have a higher risk of metabolic disease later in life, and their postnatal growth in early childhood may be associated with long-term adverse outcomes. This study aimed to determine childhood health outcomes of term LGA babies with different growth patterns. Data were obtained from the US Collaborative Perinatal Project for the years between 1959 and 1976. The growth trajectories of 3,316 term LGA babies were identified and odds ratios of obesity, growth restriction, low intelligence quotient (IQ), and high blood pressure (HBP) were calculated by logistic regression. Compared with term appropriate-for-gestational-age infants, term LGA babies without catch-down growth had increased risks of obesity (adjusted odds ratio (aOR) = 6.37, 95% confidence interval (CI): 5.24, 7.73) and HBP (aOR = 1.67, 95% CI: 1.37, 2.03). Those with high catch-down growth had higher risks of growth restriction (aOR = 2.21, 95% CI: 1.66, 2.95) and low IQ (aOR = 1.61, 95% CI: 1.04, 2.49). Nevertheless, infants with small catch-down growth had lower risks of obesity (aOR = 0.78, 95% CI: 0.63, 0.95), growth restriction (aOR = 0.28, 95% CI: 0.17, 0.46), low IQ (aOR = 0.66, 95% CI: 0.41, 1.06), and HBP (aOR = 0.89, 95% CI: 0.77, 1.04). According to our data, term LGA infants with small catch-down growth had no increased risks of adverse outcomes.
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Affiliation(s)
- Xiaoping Lei
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Neonatology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Dongying Zhao
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Lisu Huang
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhongcheng Luo
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai, People’s Republic of China
| | - Jun Zhang
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai, People’s Republic of China
| | - Xiaodan Yu
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai, People’s Republic of China
| | - Yongjun Zhang
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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The Effects of Race and Ethnicity on the Risk of Large-for-Gestational-Age Newborns in Women Without Gestational Diabetes by Prepregnancy Body Mass Index Categories. Matern Child Health J 2017; 21:1643-1654. [DOI: 10.1007/s10995-016-2256-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perrone S, Santacroce A, Picardi A, Buonocore G. Fetal programming and early identification of newborns at high risk of free radical-mediated diseases. World J Clin Pediatr 2016; 5:172-181. [PMID: 27170927 PMCID: PMC4857230 DOI: 10.5409/wjcp.v5.i2.172] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/30/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Nowadays metabolic syndrome represents a real outbreak affecting society. Paradoxically, pediatricians must feel involved in fighting this condition because of the latest evidences of developmental origins of adult diseases. Fetal programming occurs when the normal fetal development is disrupted by an abnormal insult applied to a critical point in intrauterine life. Placenta assumes a pivotal role in programming the fetal experience in utero due to the adaptive changes in structure and function. Pregnancy complications such as diabetes, intrauterine growth restriction, pre-eclampsia, and hypoxia are associated with placental dysfunction and programming. Many experimental studies have been conducted to explain the phenotypic consequences of fetal-placental perturbations that predispose to the genesis of metabolic syndrome, obesity, diabetes, hyperinsulinemia, hypertension, and cardiovascular disease in adulthood. In recent years, elucidating the mechanisms involved in such kind of process has become the challenge of scientific research. Oxidative stress may be the general underlying mechanism that links altered placental function to fetal programming. Maternal diabetes, prenatal hypoxic/ischaemic events, inflammatory/infective insults are specific triggers for an acute increase in free radicals generation. Early identification of fetuses and newborns at high risk of oxidative damage may be crucial to decrease infant and adult morbidity.
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Briana DD, Baka S, Boutsikou M, Boutsikou T, Xagorari M, Gourgiotis D, Malamitsi-Puchner A. Cord blood copeptin concentrations in fetal macrosomia. Metabolism 2016; 65:89-94. [PMID: 26477270 DOI: 10.1016/j.metabol.2015.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 09/12/2015] [Accepted: 09/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIM Excessive fetal growth is associated with increased adiposity and reduced insulin sensitivity at birth. Copeptin, a surrogate marker of arginine vasopressin (AVP) secretion, is upregulated in states of hyperinsulinemia and is considered one of the mediators of insulin resistance. We aimed to investigate cord blood concentrations of copeptin (C-terminal fragment of AVP pro-hormone) in healthy large-for-gestational-age (LGA) infants at term. METHODS This prospective study was conducted on 30 LGA (n=30) and 20 appropriate-for-gestational-age (AGA, n=20) singleton full-term healthy infants. Cord blood copeptin and insulin concentrations were determined by ELISA and IRMA, respectively. Infants were classified as LGA or AGA, based on customized birth-weight standards adjusted for significant determinants of fetal growth. RESULTS Cord blood copeptin concentrations were similar in LGA cases, compared to AGA controls, after adjusting for delivery mode. However, in the LGA group, cord blood copeptin concentrations positively correlated with birth-weight (r=0.422, p=0.020). In the AGA group, cord blood copeptin concentrations were elevated in cases of vaginal delivery vs elective cesarean section (p=0.003). Cord blood insulin concentrations were higher in LGA cases, compared to AGA controls (p=0.036). No association was recorded between cord blood copeptin concentrations and maternal age, parity, gestational age or fetal gender in both groups. CONCLUSIONS Cord blood copeptin concentrations may not be up-regulated in non-distressed LGA infants. However, the positive correlation between cord blood copeptin concentrations and birth-weight in the LGA group may point to the documented association between AVP release and increased fat deposition. Vaginal delivery vs elective cesarean section is accompanied by a marked stress-related increase of cord blood copeptin concentrations.
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Affiliation(s)
- Despina D Briana
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Stavroula Baka
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Maria Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, Athens University Medical School, Athens, Greece
| | - Marieta Xagorari
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
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Özbörü Aşkan Ö, Bozaykut A, Sezer RG, Güran T, Bereket A. Effect of Maternal Factors and Fetomaternal Glucose Homeostasis on Birth Weight and Postnatal Growth. J Clin Res Pediatr Endocrinol 2015; 7:168-74. [PMID: 26831549 PMCID: PMC4677550 DOI: 10.4274/jcrpe.1914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE It is important to identify the possible risk factors for the occurrence of large for gestational age (LGA) in newborns and to determine the effect of birth weight and metabolic parameters on subsequent growth. We aimed to determine the effects of maternal weight, weight gain during pregnancy, maternal hemoglobin A1c (HbA1c), C-peptide and insulin as well as cord C-peptide and insulin levels on birth weight and postnatal growth during the first two years of life. METHODS Healthy, non-diabetic mothers and term singleton newborns were included in this prospective case-control cohort study. Fasting maternal glucose, HbA1c, C-peptide and insulin levels were studied. Cord blood was analyzed for C-peptide and insulin. At birth, newborns were divided into two groups according to birth size: LGA and appropriate for GA (AGA). Infants were followed at six-month intervals for two years and their length and weight were recorded. RESULTS Forty LGA and 43 AGA infants were included in the study. Birth weight standard deviation score (SDS) was positively correlated with maternal body mass index (BMI) before delivery (r=0.2, p=0.04) and with weight gain during pregnancy (r=0.2, p=0.04). In multivariate analyses, the strongest association with macrosomia was a maternal C-peptide level >3.85 ng/mL (OR=20). Although the LGA group showed decreased growth by the 6-month of follow-up, the differences between the LGA and AGA groups in weight and length SDS persisted over the 2 years of follow-up. CONCLUSION The control of maternal BMI and prevention of overt weight gain during pregnancy may prevent excessive birth weight. The effect of the in utero metabolic environment on the weight and length SDS of infants born LGA persists until at least two years of age.
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Affiliation(s)
- Öykü Özbörü Aşkan
- Göztepe Medical Park Hospital, Clinic of Pediatrics, İstanbul, Turkey
| | - Abdülkadir Bozaykut
- Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Clinic of Pediatrics, İstanbul, Turkey
| | - Rabia Gönül Sezer
- Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Clinic of Pediatrics, İstanbul, Turkey Phone: +90 216 391 06 80-1434 E-mail:
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Cetin C, Baş F, Uçar A, Poyrazoğlu S, Saka N, Bundak R, Darendeliler F. Comparative analysis of glucoinsulinemic markers and proinflammatory cytokines in prepubertal children born large-versus appropriate-for gestational age. Endocrine 2014; 47:816-24. [PMID: 24557990 DOI: 10.1007/s12020-014-0207-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 02/04/2014] [Indexed: 12/30/2022]
Abstract
Children born large for gestational age (LGA) may be at risk for development of obesity and insulin resistance (IR). The reciprocal relationship of adipokines and proinflammatory cytokines is suggested to play a putative role in fine tuning of insulin secretory dynamics. To evaluate serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), leptin, insulin-like growth factor-1 (IGF-1), and IGF-binding protein-1 (IGFBP-1) concentrations in idiopathic LGA-born children to appropriate for gestational age (AGA) and idiopathic LGA-born children at prepubertal ages and investigate their associations with IR, evaluated by homeostasis model assessment-IR (HOMA-IR), we conducted a cross-sectional study to compare 40 (19 females) idiopathic LGA-born prepubertal children [mean ± SD age 6.1 ± 2.5 years] and 49 (25 females) (5.4 ± 1.8 years) AGA-born BMI-matched peers with respect to anthropometric and laboratory data. Both groups were further divided into subgroups as being obese/overweight (OW) and non-OW, and the analyses were repeated. LGA-born children were taller and heavier than AGA-born children (p < 0.001). Fasting insulin, HOMA-IR, and leptin were higher in LGA-born children than in AGA-born counterparts (p < 0.001). Serum TNF-α levels were lower and IL-6 levels were significantly higher in LGA- than in AGA-born children (p < 0.001). In the LGA group, TNF-α was correlated with HOMA-IR (r = -0.49, p = 0.002). LGA-born non-OW children had higher serum insulin concentrations and HOMA-IR than AGA-born counterparts. Multivariate regression analysis revealed that HOMA-IR was best explained by (R (2) = 0.517) birth weight SDS (β = +0.418, p = 0.002), leptin (β = +0.620, p = 0.000), and TNF-α (β = -0.374, p = 0.003) in LGA-born children. Idiopathic LGA-born children have significantly lower TNF-α and higher IL-6 levels than AGA-born children. Reduced TNF-α levels are associated with increased IR.
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Affiliation(s)
- Ceren Cetin
- Paediatric Endocrinology Unit, Department of Paediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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Progression of cardio-metabolic risk factors in subjects born small and large for gestational age. PLoS One 2014; 9:e104278. [PMID: 25117750 PMCID: PMC4130586 DOI: 10.1371/journal.pone.0104278] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/10/2014] [Indexed: 01/31/2023] Open
Abstract
Background Subjects born small (SGA) and large (LGA) for gestational age have an increased risk of cardio-metabolic alterations already during prepuberty. Nevertheless, the progression of their cardio-metabolic profile from childhood to adolescence has not been fully explored. Our aim was to assess potential changes in the cardio-metabolic profile from childhood to adolescence in subjects born SGA and LGA compared to those born appropriate (AGA) for gestational age. Methods This longitudinal study included 35 AGA, 24 SGA and 31 LGA subjects evaluated during childhood (mean age (±SD) 8.4±1.4 yr) and then re-assessed during adolescence (mean age 13.3±1.8 yr). BMI, blood pressure, insulin resistance (fasting insulin, HOMA-IR) and lipids were assessed. A cardio-metabolic risk z-score was applied and this consisted in calculating the sum of sex-specific z-scores for BMI, blood pressure, HOMA-IR, triglycerides and triglycerides:high-density lipoprotein cholesterol ratio. Results Fasting insulin and HOMA-IR were higher in SGA and LGA than AGA subjects both during childhood (all P<0.01) and adolescence (all P<0.01). Similarly, the clustered cardio-metabolic risk score was higher in SGA and LGA than AGA children (both P<0.05), and these differences among groups increased during adolescence (both P<0.05). Of note, a progression of the clustered cardio-metabolic risk score was observed from childhood to adolescence within SGA and within LGA subjects (both P<0.05). Conclusions SGA and LGA subjects showed an adverse cardio-metabolic profile during childhood when compared to AGA peers, with a worsening of this profile during adolescence. These findings indicate an overtime progression of insulin resistance and overall estimated cardiovascular risk from childhood to adolescence in SGA and LGA populations.
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Shan X, Chen F, Wang W, Zhao J, Teng Y, Wu M, Teng H, Zhang X, Qi H, Liu X, Tan C, Mi J. Secular trends of low birthweight and macrosomia and related maternal factors in Beijing, China: a longitudinal trend analysis. BMC Pregnancy Childbirth 2014; 14:105. [PMID: 24641671 PMCID: PMC4003827 DOI: 10.1186/1471-2393-14-105] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 03/11/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Information tracking changes of birthweight is scarce in China. To examine trends of low birthweight (birthweight < 2500 g) and macrosomia (birthweight ≥ 4000 g) and potential risk factors in Beijing, hospital records from two major obstetrics and gynecology hospitals in urban districts in Beijing were analyzed. METHODS Hospital records from 1996 to 2010 were retrieved. Information of prenatal examination and birth outcomes was entered into a structured database. Live births were used for trend analysis. Information of live births in 2010 was used to identify potential risk factors. RESULTS A total of 63 661 live births were delivered during 1996-2010 in the study hospitals. The average birthweight increased from 3271 g in 1996 to 3 359 g in 2000 and slightly declined to 3 331 in 2010. The percentage of low birthweight fluctuated around 4.0%. No significant increase or decrease was observed. Preterm birth was the main cause of low birthweight, accounting for more than 73% of low birthweight. The average percentage of macrosomia was 7.6%. The percentages of macrosomia increased from 6.6% in 1996 to 9.5% in 2000 and declined to 7.0% in 2010. Excessive gestational weight gain and gestational diabetes were significantly associated with macrosomia. CONCLUSIONS Continuously monitoring abnormal birthweight is needed and intervention should focus on appropriate gestational weight gain and reduction of preterm birth and gestational diabetes.
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Affiliation(s)
- Xiaoyi Shan
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Fangfang Chen
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Wenpeng Wang
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Juan Zhao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yue Teng
- HAIDIAN Maternity and Child Health Care Hospital, Beijing, China
| | - Minghui Wu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Honghong Teng
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hong Qi
- HAIDIAN Maternity and Child Health Care Hospital, Beijing, China
| | - Xiaohong Liu
- HAIDIAN Maternity and Child Health Care Hospital, Beijing, China
| | - Chunying Tan
- HAIDIAN Maternity and Child Health Care Hospital, Beijing, China
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing 100020, China
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Abstract
PURPOSE OF REVIEW The prevalence of obesity is on the increase, and consequently metabolic syndrome is also becoming a serious health problem in children and adolescents all over the world. This review attempts to summarize the recent literature on metabolic syndrome in children and adolescents. RECENT FINDINGS To date, a standard definition of metabolic syndrome for the pediatric population is not available. Recently, the International Diabetes Federation has proposed a new set of criteria to define metabolic syndrome in children and adolescents aged 6-16 years. The relationships between obesity, insulin resistance and metabolic syndrome may be explained by the pattern of lipid partitioning. Fatty liver plays a central role in the insulin-resistant state in obese adolescents. Although insulin resistance has been proposed as the central factor leading to the abnormalities observed in metabolic syndrome, most definitions of metabolic syndrome use impaired fasting glucose as a marker. Nutrition impairment during both prenatal and early postnatal life can cause metabolic disturbances leading to insulin-resistance, type 2 diabetes, hypertension and cardiovascular disease. SUMMARY Metabolic syndrome prevalence in children and adolescents is on the increase. Therefore, the emphasis in all studies and programs related to metabolic syndrome should be focused on prevention, early detection of metabolic risk factors and interventions that will have a significant impact on future adult health.
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Affiliation(s)
- Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
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Brumbaugh DE, Friedman JE. Developmental origins of nonalcoholic fatty liver disease. Pediatr Res 2014; 75:140-7. [PMID: 24192698 PMCID: PMC4081536 DOI: 10.1038/pr.2013.193] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/06/2013] [Indexed: 02/07/2023]
Abstract
Obese pregnant women may transmit their metabolic phenotype to offspring, leading to a cycle of obesity and diabetes over generations. Early childhood obesity predicts nonalcoholic fatty liver disease (NAFLD), the most common chronic human liver disease. The fetus may be vulnerable to steatosis because immature fetal adipose depots are not available to buffer the excess transplacental lipid delivery in maternal obesity. In animal models, in utero high-fat diet exposure results in an increase in the accumulation of liver triglycerides in offspring and increased hepatic oxidative stress and apoptosis, perhaps priming the liver for later development of NAFLD. Innate immune dysfunction and necroinflammatory changes have been observed in postnatal offspring liver of animals born to high-fat-fed dams. Postweaning, livers of offspring exposed to maternal high-fat feeding in utero share pathophysiologic features with human NAFLD, including increased de novo lipogenesis and decreased free fatty acid oxidation. Human studies using magnetic resonance imaging have shown that maternal BMI predicts infant intrahepatocellular lipid storage, as seen in animal models. The generational transfer of NAFLD may occur via epigenetic changes in offspring liver. Transmission of microbiota from mother to infant may impact energy retention and immune function that contribute to a predisposition to NAFLD.
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Affiliation(s)
- David E. Brumbaugh
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jacob E. Friedman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado,Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado
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Tanda R, Salsberry PJ, Reagan PB, Fang MZ. The impact of prepregnancy obesity on children's cognitive test scores. Matern Child Health J 2013; 17:222-9. [PMID: 22350633 DOI: 10.1007/s10995-012-0964-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. A descriptive observational design was used. Study subjects consist of 3,412 US children aged 60-83 months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Children of obese women had 3 points (0.23 SD units) lower peabody individual achievement test (PIAT) reading recognition score (p = 0.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (p < 0.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: β = 0.15, p < 0.0001, and math: β = 0.15, p < 0.0001), household income (reading: β = 0.03, p = 0.02 and math: β = 0.04, p = 0.004), maternal education (reading: β = 0.42, p = 0.0005, and math: β = 0.32, p = 0.008), and maternal cognitive skills (reading: β = 0.11, p < 0.0001, and math: β = 0.09, p < 0.0001). There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.
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Affiliation(s)
- Rika Tanda
- The College of Nursing, The Ohio State University, Columbus, OH, USA.
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Hopper MK, Brown GW, Funke KA, Pike Brown LR. Prevalence of hyperinsulinemia associated with body mass index, genetic predisposition, and lifestyle in college freshmen students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:27-36. [PMID: 22171727 DOI: 10.1080/07448481.2011.562577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE College lifestyle places an individual at greater risk for the development of insulin resistance (IR) and disease. The aim of this study was to establish a baseline measurement of insulin, and other variables influencing IR in college freshmen. PARTICIPANTS Twenty-two men and women, 18 to 19 years of age, during first month of college. METHODS Following 12-hour fast, subjects reported to the laboratory for determination of body mass index (BMI) and completion of questionnaire determining ethnicity, family history, and patterns of diet, exercise, and stress. Blood samples were obtained and analyzed for glucose and insulin. RESULTS Mean insulin value for men (14.9 ± 1.86 μU/mL) was normal, and that for women (17.3 ± 1.74 μU/mL) was slightly elevated. When subjects were grouped by BMI, genetic predisposition, and summated lifestyle risk, fasting insulin values were significantly different. Eight of 22 subjects were hyperinsulinemic (insulin >19 μU/mL). CONCLUSION Hyperinsulinemia is prevalent in this population and merits further investigation and intervention.
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Affiliation(s)
- Mari K Hopper
- Department of Biology, University of Southern Indiana, Evansville, Indiana 47712, USA.
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Savvidou MD, Akolekar R, Samaha RBB, Masconi AP, Nicolaides KH. Maternal serum 25-hydroxyvitamin D levels at 11(+0) -13(+6) weeks in pregnant women with diabetes mellitus and in those with macrosomic neonates. BJOG 2011; 118:951-5. [PMID: 21658195 DOI: 10.1111/j.1471-0528.2011.02982.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate whether maternal serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester are altered in pregnant women with pre-existing type 2 diabetes, women who subsequently develop gestational diabetes mellitus (GDM) and women who deliver large for gestational age (LGA) neonates compared with normoglycaemic pregnant women who deliver an appropriate for gestational age (AGA) neonate. DESIGN Case-control study. SETTING Antenatal clinic. POPULATION Singleton pregnancies at 11(+0) -13(+6) weeks, including 50 women with type 2 diabetes, 100 women who subsequently developed GDM, 50 nondiabetic women who subsequently delivered LGA neonates and 1000 nondiabetic controls who delivered AGA neonates. METHODS Maternal serum total 25(OH)D levels were measured in the four groups of pregnancies. Multiple regression analysis in the controls was used to identify factors among maternal characteristics with a significant contribution to the levels of serum 25(OH)D, so that the values in all cases were expressed as a multiple of the median (MoM) in the controls. MAIN OUTCOME MEASURES Comparison of MoM 25(OH)D in the four groups. RESULTS In controls, significant independent contributions to the serum level of 25(OH)D were provided by maternal age, body mass index, smoking status, racial origin and season of sampling. The median and interquartile range (IQR) of serum 25(OH)D in the type 2 diabetes group (1.01; IQR, 0.68-1.47 MoM), GDM group (0.93; IQR, 0.67-1.23 MoM) and LGA group (0.97; IQR, 0.67-1.25 MoM) were not significantly different from those in the controls (0.99; IQR, 0.71-1.33 MoM) (overall P = 0.643). CONCLUSIONS The first-trimester maternal serum level of 25(OH)D is not altered in women with type 2 diabetes, those who develop GDM or those who deliver LGA neonates.
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Affiliation(s)
- M D Savvidou
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London UK.
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Hernández MI, Mericq V. Metabolic syndrome in children born small-for-gestational age. ACTA ACUST UNITED AC 2011; 55:583-9. [DOI: 10.1590/s0004-27302011000800012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/16/2011] [Indexed: 02/08/2023]
Abstract
Being born small-for-gestational age and a rapid increase in weight during early childhood and infancy has been strongly linked with chronic diseases, including metabolic syndrome, which has been related to intrauterine life environment and linked to epigenetic fetal programming. Metabolic syndrome includes waist circumference > 90th percentile for age, sex and race, higher levels of blood pressure, triglycerides and fasting glucose, and low levels of HDL-cholesterol. Insulin resistance may be present as early as 1 year of age, and obesity and/or type 2 diabetes are more prevalent in those born SGA than those born AGA. The programming of adaptive responses in children born SGA includes an association with increased blood pressure, changes in endothelial function, arterial properties and coronary disease. Early interventions should be directed to appropriate maternal nutrition, before and during pregnancy, promotion of breast feeding, and prevention of rapid weight gain during infancy, and to promote a healthy lifestyle.
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Feig DS, Moses RG. Metformin therapy during pregnancy: good for the goose and good for the gosling too? Diabetes Care 2011; 34:2329-30. [PMID: 21949224 PMCID: PMC3177745 DOI: 10.2337/dc11-1153] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Denice S. Feig
- From the Department of Medicine, University of Toronto, Toronto, Ontario, Canada; the
- Division of Endocrinology, Mount Sinai Hospital, Toronto, Ontario, Canada; the
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; the
| | - Robert G. Moses
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; and the
- University of Wollongong, Wollongong, New South Wales, Australia
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Renom Espineira A, Fernandes-Rosa FL, Bueno AC, de Souza RM, Moreira AC, de Castro M, Barbieri MA, Bettiol H, Antonini SR. Postnatal growth and cardiometabolic profile in young adults born large for gestational age. Clin Endocrinol (Oxf) 2011; 75:335-41. [PMID: 21521322 DOI: 10.1111/j.1365-2265.2011.04054.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT The association between large for gestational age (LGA) phenotype, postnatal growth and cardiometabolic risk (CMR) in adult life remains unclear. The role of IGF1 genotype on LGA-related outcomes in adult life is unknown. AIM To assess the postnatal growth, IGF-I levels, CMR and the influence of the 737.738 IGF1 in adults born LGA. SUBJECTS Case-control study (n = 515) nested in a population-based prospective cohort (n = 2063); 117 LGA and 398 gender-matched controls appropriate for gestational age (AGA) subjects. METHODS Anthropometry was evaluated at birth, at 9-10 and at 23-25 years old. At the age of 23-25 years, blood pressure (BP), glycaemia, insulinaemia, homeostasis model assessment - insulin resistance, lipids, fibrinogen, and plasma IGF-I and 737.738 IGF1 polymorphism were assessed. RESULTS Large for gestational age subjects remained heavier and taller than AGA at 9-10 and 23-25 years (P < 0·05); at 23-25 years, LGA had greater waist circumference (WC; P < 0·05) and higher BP (P < 0·05) than controls. Body proportionality at birth did not predict metabolic outcome. LGA subjects presenting catch-down of weight in childhood had lower body mass index (BMI; P = 0·001), lower WC (P < 0·05) and lower BP (P < 0·05) at 23-25 years. 737.738 IGF-I genotype differed between groups (P < 0·001). Homozygosis for polymorphic alleles was associated with increased odds of LGA (OR: 3·2; 95% CI: 1·5-6·9), higher IGF-I (56·9 ± 16·4 vs 37·7 ± 16·0 nm; P < 0·01) and lower BP (114/68 vs 121/73 mmHg; P < 0·05). CONCLUSIONS Young adults born LGA presented higher BMI, WC and BP and appear to be at higher CMR risk than AGA subjects. The 737.738 IGF1 polymorphism appears to play a role on birth size and LGA-related metabolic outcomes.
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Affiliation(s)
- Aniette Renom Espineira
- Department of Pediatrics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
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Valsamakis G, Margeli A, Vitoratos N, Boutsiadis A, Sakkas EG, Papadimitriou G, Al-Daghri NM, Botsis D, Kumar S, Papassotiriou I, Creatsas G, Mastorakos G. The role of maternal gut hormones in normal pregnancy: fasting plasma active glucagon-like peptide 1 level is a negative predictor of fetal abdomen circumference and maternal weight change. Eur J Endocrinol 2010; 162:897-903. [PMID: 20194524 DOI: 10.1530/eje-10-0047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Maternal weight in pregnancy contributes to a glycemic environment that affects fetal growth. Gut peptides (glucagon-like peptide 1 (GLP1), glucose-dependent insulinotropic peptide (GIP), ghrelin, and peptide YY (PYY)) have been related to insulin sensitivity and secretion, weight control, and adipose tissue metabolism. This study aimed at examining the associations of gut hormones during pregnancy with maternal glucose homeostasis, maternal weight, and fetal growth. METHODS A total of 55 pregnant nonobese, nondiabetic Caucasian women were examined during the three trimesters of pregnancy, and anthropometric measurements, evaluation of fasting maternal plasma GLP1 (active), ghrelin (active), total PYY, total GIP, and a 75-g oral glucose tolerance test were done in them. Homeostasis model assessment (HOMA-R), insulin sensitivity index (ISI), and indices of insulin secretion were calculated. Fetal growth was estimated by ultrasound. RESULTS Fasting GLP1 increased significantly from the second to the third trimester (P<0.05). Fasting GLP1 correlated positively with high-density lipoprotein cholesterol (r=0.52, P=0.04). At the second trimester, fasting GLP1 levels correlated negatively with fetal abdomen circumference (r=-0.55, P=0.034), birth weight (r=-0.50, P=0.040), HOMA-R (r=-0.65, P=0.001), insulin secretion, and triglycerides. At the first trimester, fasting ghrelin levels correlated negatively with HOMA-R and insulin secretion, and positively with ISI. In backward multiple regression analysis, the first trimester GLP1 levels were the best negative predictors of the second trimester fetal abdomen circumference (beta=-0.96, P=0.009). In longitudinal regression model, maternal fat and HOMA-R were the positive predictors of maternal weight change during pregnancy, and fasting GLP1 levels were the negative predictors of maternal weight change during pregnancy. CONCLUSIONS During pregnancy, maternal GLP1 might be involved in mechanisms that compensate for the pregnancy-related increase in glycemia and insulin resistance, suggesting a role of this peptide in maternal metabolism and weight and fetal growth.
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Affiliation(s)
- Georgios Valsamakis
- 2nd Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, Athens, Greece
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Bueno AC, Espiñeira AR, Fernandes-Rosa FL, de Souza RM, de Castro M, Moreira AC, Bettiol H, Barbieri MA, Antonini SR. Adiponectin: serum levels, promoter polymorphism, and associations with birth size and cardiometabolic outcome in young adults born large for gestational age. Eur J Endocrinol 2010; 162:53-60. [PMID: 19841046 DOI: 10.1530/eje-09-0697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess whether the -11391G>A polymorphism in the regulatory region of the adiponectin gene (ADIPOQ) is associated with birth size, postnatal growth, adiponectinemia, and cardiometabolic risk in adult life. DESIGN Case-control study nested within a prospective cohort of 2063 community subjects born in 1978/1979 and followed since birth to date. METHODS ADIPOQ -11391G>A genotype-phenotype associations were evaluated in 116 subjects born large for gestational age (LGA) and 392 gender-matched controls at birth (birth size), at 8-10 years (catch-down growth), and at 23-25 years of age (cardiometabolic profile). RESULTS The -11391A variant allele frequency was higher in LGA subjects (P=0.04). AA genotype was associated with augmented probability of being born LGA (odds ratio=4.14; 95% confidence interval: 1.16-16.7; P=0.03). This polymorphism was associated neither with body composition nor with postnatal growth pattern. At the age of 23-25 years, the -11391A variant allele was associated with higher serum adiponectin levels (GG: 10.7+/-6.2 versus GA: 12.2+/-6.5 versus AA: 14.2+/-6.8 microg/ml; P<0.01). Subjects born LGA presented higher body mass index (BMI; P=0.01), abdominal circumference (P=0.04), blood pressure (P=0.04), and homeostasis assessment model for insulin resistance (P=0.01) than adequate for gestational age. Symmetry at birth did not influence these variables. The occurrence of catch-down of weight was associated with lower BMI and abdominal circumference (P<0.001) at 23-25 years. CONCLUSIONS The -11391A ADIPOQ gene variant was associated with increased chance of being born LGA and with higher adiponectin levels in early adult life.
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Affiliation(s)
- Ana Carolina Bueno
- Department of Pediatrics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Monte Alegre, Ribeirao Preto, Sao Paulo, Brazil
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Affiliation(s)
- Zachary T. Bloomgarden
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York
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Catalano PM, Presley L, Minium J, Hauguel-de Mouzon S. Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care 2009; 32:1076-80. [PMID: 19460915 PMCID: PMC2681036 DOI: 10.2337/dc08-2077] [Citation(s) in RCA: 455] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Offspring of obese mothers have an increased risk for obesity and diabetes. The purpose of this study was to determine whether fetuses of obese women have increased obesity, insulin resistance, and markers of inflammation, supporting the concept of fetal programming. RESEARCH DESIGN AND METHODS Fifty-three lean and 68 obese women with singleton term pregnancies were evaluated at elective cesarean delivery. Maternal and umbilical cord blood was obtained for measures of insulin resistance and cytokines. Neonatal body composition was estimated using anthropometric measurements within 24 h of delivery. RESULTS The fetuses of obese mothers had greater percent body fat (13.1 +/- 3.4 vs. 11.6 +/- 2.9%, P = 0.02), homeostasis model assessment of insulin resistance (1.51 +/- 0.86 vs. 1.06 +/- 0.70, P = 0.003), cord leptin (14.5 +/- 13.5 vs. 8.2 +/- 4.7 ng/ml, P = 0.001), and interleukin-6 (3.5 +/- 2.3 vs. 2.4 +/- 1.4 pg/ml, P = 0.02) than fetuses of lean women. There was a strong positive correlation between fetal adiposity and insulin resistance (r = 0.32, P = 0.0008) as well as maternal pregravid BMI and fetal insulin resistance (r = 0.31, P = 0.007) even with adjustment for potential confounders. Cord leptin had a significant correlation with fetal insulin resistance (r = 0.30, P = 0.001), but there was no significant correlation between any other umbilical cord cytokines and fetal insulin resistance. CONCLUSIONS These data suggest that maternal obesity creates a significant risk for the next generations with metabolic compromise already apparent at birth. Therefore, if prevention of obesity is the goal rather than treatment, the perinatal period may be an important focus of future research.
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Affiliation(s)
- Patrick M Catalano
- Department of Reproductive Biology, Case Western Reserve University at Metro Health Medical Center, Cleveland, Ohio, USA.
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Darendeliler F, Poyrazoglu S, Sancakli O, Bas F, Gokcay G, Aki S, Eskiyurt N. Adiponectin is an indicator of insulin resistance in non-obese prepubertal children born large for gestational age (LGA) and is affected by birth weight. Clin Endocrinol (Oxf) 2009; 70:710-6. [PMID: 18759869 DOI: 10.1111/j.1365-2265.2008.03394.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Being born as large for gestational age (LGA) has an increased risk of developing insulin resistance. Hypoadiponectinaemia is associated with insulin resistance. The aim of this study was to evaluate adiponectin levels and insulin resistance in association with body composition in LGA born non-obese children at prepubertal ages. PATIENTS AND METHODS Thirty-five (17 female and 18 male) LGA born non-obese children (mean age 4.8 +/- 0.3 years) were evaluated with respect to glucose, insulin, IGFBP-1, leptin, adiponectin levels and body composition by DEXA. Their data were compared to that of non-obese 49 (20 female, 29 male) appropriate for gestational age (AGA) children (mean age 3.8 +/- 0.1 year). RESULTS LGA children, who had similar body mass index standard deviation scores (BMI SDS) as AGA children, had significantly higher insulin (P = 0.043) and statistically borderline significant homeostasis model assessment-insulin resistance (HOMA-IR) levels (P = 0.054) than those of AGA children. Adiponectin levels were significantly lower in LGA than AGA children (P = 0.004) even after controlling for age, sex and BMI (P = 0.016). IGFBP-1, leptin levels and body composition did not show a difference. When the LGA group was divided into subgroups according to birth weight, the analysis revealed that after controlling for BMI, being an LGA and having a higher birth weight in the upper half were associated with lower adiponectin levels (estimated marginal means of logarithmic adiponectin levels 2.6 +/- 0.2 vs. 2.1 +/- 0.2 microg/ml, P = 0.042). CONCLUSION LGA children have higher insulin and lower adiponectin levels than AGA children in spite of similar BMI. Adiponectin is a better indicator of insulin resistance in LGA children at prepubertal ages and is affected by birth weight.
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Affiliation(s)
- Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Beltrand J, Verkauskiene R, Nicolescu R, Sibony O, Gaucherand P, Chevenne D, Claris O, Lévy-Marchal C. Adaptive changes in neonatal hormonal and metabolic profiles induced by fetal growth restriction. J Clin Endocrinol Metab 2008; 93:4027-32. [PMID: 18682508 DOI: 10.1210/jc.2008-0562] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Birth weight (BW) is usually taken as a surrogate of fetal growth. However, BW per se is not relevant enough in assessing fetal growth restriction, which by itself may alter body composition, metabolic, and hormonal profiles at birth (irrespective of BW), reflecting the necessary adaptive changes in metabolism under poor fetal environment. OBJECTIVE Our objective was to measure body composition, hormonal, and metabolic parameters at birth in relation to both BW and fetal growth velocity. METHODS A total of 235 pregnancies at risk of low BW were included, and newborns were observed at birth. Fetal growth velocity was calculated as the change in customized percentiles of estimated fetal weight between 22 wk gestational age and birth. Newborns were ranked in descending order of fetal growth velocity and divided in three equal tertiles. RESULTS The lower fetal growth velocity tertile showed a severe fetal growth restriction (-52% +/- 21%) and was significantly associated with reduced lean and fat mass (P < 0.001 and 0.02, respectively). Insulin concentration was significantly related to fetal growth velocity (P = 0.006) and fat mass (P = 004) but not to BW (grams), whereas fetal growth velocity (P = 0.002) and BW (P < 0.001) but not fat mass had a significant effect on IGF-I concentration at birth. CONCLUSION Fetal growth restriction induces changes in body composition and metabolism suggestive of a higher insulin sensitivity independently from BW itself, reflecting adaptive changes to an adverse fetal nutritional environment.
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Affiliation(s)
- Jacques Beltrand
- Institut National de la Santé et de la Recherché Médicale Unit 690, 48 Boulevard Sérurier, 75019 Paris, France.
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