Association of maternal nutrition with transient neonatal hyperinsulinism

Exploring Lifestyle and Dietary Patterns in Pregnancy and Their Impact on Health: A Comparative Analysis of Two Distinct Groups 10 Years Apart

The significance of dietary patterns during pregnancy is highlighted by accumulating evidence, emphasizing their pivotal role in promoting a healthy pregnancy for both the mother and the child. This study aimed to assess the current dietary patterns of pregnant women, compare the energy and nutrient intake of two distinct groups with a 10-year interval, and identify changes in dietary patterns. EPIC FFQ was applied, and its data were interpreted with the FETA program version 6 (CAMB/PQ/6/1205). By means of principal component analysis, three different food patterns were identified in each study group: vegetarian, balanced, and traditional (2013); and prudent, vegetarian, and modern (2023). Analyzing the relationship between food groups and gestational weight, we found that gestational weight gain in 2013 was positively correlated with eggs and egg dishes and milk and milk products, whereas in 2023, gestational weight gain was positively correlated with fats and oils, non-alcoholic beverages, and the modern pattern. Additionally, in 2023, pre-gestational BMI correlated positively with eggs and egg dishes. The balanced pattern emerged as a predictor for a lower likelihood of inadequate gestational weight gain in both groups. Furthermore, normal and overweight pregnant women showed a reduced likelihood of excessive gestational weight gain.

Association between maternal factors and fetal macrosomia in full-term singleton births

BACKGROUND

Macrosomia, defined as a birth weight of ≥4000 g, is associated with a high risk of birth injury. Fetal growth is highly correlated with maternal conditions, and several maternal factors are associated with neonatal birth size. The current study aimed to assess maternal factors related to fetal macrosomia in a Taiwanese population.

METHODS

The medical records of pregnant mothers and their newborns were retrospectively reviewed. All singleton pregnancies delivered at and after 37 weeks of gestation were included in the analysis. Maternal and neonatal conditions were evaluated according to different birth weights.

RESULTS

A total of 4262 infants were enrolled in our study. The mean birth weight was 3156 ± 383 g, including 77 (1.8%) cases with birth weight ≥4000 g, and 154 (3.6%) infants with birth weight <2500 g. The mean maternal body weight before delivery was 67.6 ± 10.0 kg. The mean 6-month gestational weight gain (6mGWG) was 12.3 ± 4.2 kg, and the mean maternal body mass index (BMI) was 26.2 ± 3.6 kg/m 2 . The maternal weight, height, and 6mGWG, gestational age, and placental weight were significantly positively correlated with neonatal birth weight. The odds ratios of macrosomia were 3.1 in neonates born to mothers with a 6mGWG of ≥15 kg, 6.3 in those born to mothers with gestational diabetes mellitus, and 4.1 in those born to mothers with a BMI of ≥30 kg/m 2 . Newborn macrosomia was associated with adverse events in pregnant mothers and newborn infants.

CONCLUSION

Gestational diabetes mellitus, 6mGWG, and maternal BMI are significantly correlated with neonatal macrosomia in full-term singleton births. Further, neonatal macrosomia is an important cause of maternal and neonatal morbidity. Hence, pregnant women should undergo maternal counseling for weight management before and during pregnancy, and the appropriate delivery method should be identified to prevent perinatal adverse events.

Adherence to Clinical Practice Guideline Recommendations in Women with Gestational Diabetes and Associations with Maternal and Infant Health—A Cohort Study

Gestational diabetes mellitus (GDM) is managed by dietary advice, but limited evidence exists about the impact of adherence on health. We assessed whether adherence to the New Zealand Ministry of Health dietary recommendations is associated with maternal and infant health in women with GDM. Data from 313 women with GDM were used. Adherence to food-related recommendations was scored from 0 (no adherence) to 10 (adhered to all recommendations) and analysed in tertile groups (high, moderate, low adherence). Adherence to visiting a dietitian and appropriate weight gain were assessed as yes or no. Chi-square, ANOVA, and odds ratios were used to compare groups. High dietary adherence compared to low adherence was associated with reduced oral hypoglycaemic and insulin use (OR = 0.55, CI = 0.30–1.00). Visiting a dietitian compared to not was associated with increased oral hypoglycaemic and insulin use (OR = 2.96, CI = 1.12–7.80), decreased odds of a large-for-gestational-age infant (OR = 0.32, CI = 0.14–0.73) and neonatal hyperbilirubinaemia (OR = 0.27, CI = 0.08–0.95). Greater than recommended compared with recommended weight gain was associated with increased oral hypoglycaemic and insulin use (OR = 2.51, CI = 1.26–5.01), while lower than recommended weight gain was associated with decreased postpartum haemorrhage (OR = 0.45, CI = 0.23–0.91) and increased breastfeeding (OR = 1.96, CI = 1.04–3.70). Adherence to dietary recommendations for women with GDM likely improves health outcomes.

Does the Change in the Diagnostic Criteria for Gestational Diabetes in Poland Affect Maternal and Fetal Complications? A Prospective Study

Background and objectives: Gestational diabetes mellitus (GDM) is a significant risk factor of maternal and fetal complications. The aim of the study was to compare two groups of patients with GDM treated in 2015/2016 (Group-15/16), and in 2017/2018 (Group-17/18) and to answer the question whether the change in the diagnostic criteria for GDM affected maternal and fetal complications. Materials and Methods: A retrospective analysis was conducted. The study included 123 patients with GDM (58 patients/Group-15/16 and 65 patients/Group-17/18). Results: No significant differences were found between the groups. In Group-17/18, GDM was significantly more often diagnosed based on fasting glycemia (33.8%) compared with Group-15/16 (22.4%; p = 0.000001). GDM was significantly more often diagnosed based on 2-h oral glucose tolerance test (OGTT; 44.8%) compared with Group-17/18 (29.2%; p = 0.000005). In Group-15/16, insulin was started in 51.7% of patients compared with 33.8% in Group-17/18 (p = 0.04287). Despite more frequent insulin therapy in Group-15/16, insulin was started later (30th week of gestation) and significantly more frequently in older patients and those with higher BMI values compared with Group-17/18 (27th week of pregnancy). The number of caesarean sections and spontaneous deliveries was also similar in both periods. No difference was found in the prevalence of neonatal complications, including neonatal hypo-glycemia, prolonged jaundice or heart defect. In addition, no differences were found between the parameters in newborns. Conclusions: The change in the criteria for the diagnosis and treatment of GDM translated into the mode of diagnosis and currently it is more often diagnosed based on abnormal fasting glycemia. Currently, a lower percentage of patients require insulin therapy. However, less frequent inclusion of insulin may result in higher postprandial glycemia in the third trimester of pregnancy in mothers, thus increasing the risk of neonatal hypoglycemia immediately after delivery.

Clinical Predictors of Transient versus Persistent Neonatal Hyperinsulinism

INTRODUCTION

Hyperinsulinism (HI), the most common neonatal cause of persistent hypoglycemia, can be associated with prolonged hospitalizations and risk for long-term neurological sequelae. Rapid identification of transient versus persistent forms of HI is crucial to optimize management.

OBJECTIVES

The aims of the study were to assess the ability of clinical and biochemical features at presentation to predict transient versus persistent HI, and to evaluate differences in hospital outcomes.

METHODS

This study is a retrospective review of 79 infants with HI admitted to the Hospital for Sick Children, Toronto, from 2012 to 2017. Patients were classified into 3 groups: transient and the 2 persistent forms, diazoxide responsive and diazoxide unresponsive (DU).

RESULTS

Infants with birth weight >90th percentile had an 8-fold increased risk of having a persistent form of HI (OR 8.8, 95% CI 2.5-30) and a 21-fold increased risk of having a DU form of HI (OR 21.1, 95% CI 4.9-91.8). The majority of children with transient HI and a birth weight >90th percentile were born to mothers with gestational diabetes. There were no other useful clinical or biochemical presenting features that differentiated the groups. There were significant differences in outcome measures, with the DU children more likely to require gastrostomy tube insertion and have an extended length of hospital admission.

CONCLUSION

A higher birth weight in the absence of maternal gestational diabetes is highly associated with a persistent form of HI. Given the marked difference in clinical outcomes between groups, expedited genetic testing should be considered in infants with this presentation to inform clinical management.

Higher C-peptide levels and glucose requirements may identify neonates with transient hyperinsulinism hypoglycemia who will benefit from diazoxide treatment

The aim of the study was to characterize factors that may serve as clinical tools to identify neonates with transient neonatal hyperinsulinism hypoglycemia (HH) who may benefit from diazoxide treatment. This retrospective study included 141 neonates with transient HH (93 males) of whom 34 (24%) were treated with diazoxide. Diazoxide treatment was started at median age of 13 days (range 5-35) and discontinued at median age of 42 days (range 14-224). The maximal dose was 7.1 ± 2.3 mg/kg/day. Diazoxide-treated neonates required a higher glucose infusion rate (GIR) compared with non-treated neonates (16.6 ± 3.4 vs. 10.4 ± 4.0 mg/kg/min, respectively, P < .01), had a longer duration of intravenous fluids (15.9 ± 9.3 vs. 7.8 ± 6.5 days, P < .01), a longer hospitalization (32.8 ± 22.7 vs. 20.4 ± 13.4 days, P < .01), a longer duration of carbohydrate supplementation (38.9 ± 40.4 vs. 17.8 ± 21.4 days, P < .01), and higher mean C-peptide levels on "critical sample" (1.4 ± 0.9 vs. 0.8 ± 0.5 ng/ml, P < .01). Their insulin levels also tended to be higher (3.5 ± 2.9 vs. 2.2 ± 3.8 μU/ml, P = .07). A stepwise logistic regression model revealed that significant predictors of prolonged HH were maximal GIRs (odds ratio (OR) 1.56, 95%; confidence interval (CI) 1.3-1.88, P < .001) and C-peptide levels (OR 3.57, 95%; CI 1.3-12.1, P = .005).Conclusion: Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.What is Known:• Neonates with transient hyperinsulinism usually do not require treatment beyond glucose supplementation due to its self-limited clinical course, but some may benefit from diazoxide treatment.What is New:• Higher C-peptide levels and higher GIR requirements may serve as clinical tools to identify neonates with transient HH who may benefit from diazoxide treatment.• The incidence of prolonged neonatal HH is higher than the currently accepted figures.