Skin Autofluorescence of Pregnant Women With Diabetes Predicts the Macrosomia of Their Children

Investigating the Role of Skin Autofluorescence in Gestational Diabetes Mellitus: A Systematic Review

Gestational diabetes mellitus (GDM) is a pregnancy-specific condition that can cause serious complications for both the mother and the fetus. Preventing these complications requires optimum glycemic control. Skin autofluorescence (SAF) is a non-invasive and innovative method that evaluates the levels of advanced glycation end products, markers of hyperglycemia, that could aid in the optimum management of GDM-complicated pregnancies. This systematic review aims to assess SAF's potential utility in the prediction of short-term and long-term outcomes in GDM. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, with the protocol identifier CRD42024559012, we used "(skin autofluorescence OR SAF) AND (gestational diabetes mellitus OR GDM)" as a search criterion on the PubMed, Scopus, and Web of Science databases. After a rigorous selection process, we included five articles, which evaluated SAF values and GDM, SAF and pregnancies complicated by diabetes mellitus, and SAF and macrosomia. GDM diagnosis varies due to the different approaches among the major guidelines, leading to variations in interpretation and diagnostic thresholds. Across studies, this variability contributes to inconsistent SAF values. As a standardized and objective marker, SAF could provide a uniform criterion, improving GDM management. Further research is needed to validate its clinical utility.

Skin autofluorescence of advanced glycation end-products, glycemic memory, and diabetes complications

Since the pionneer work of Meerwaldt and the Groningen team, who related skin autofluorescence (SAF) to the dermal concentrations of advanced glycation end-products (AGEs), hundreds of articles have been devoted to its application in diabetes. Due to the slow turnover of the AGEs formed on collagen of the skin, the SAF can reflect the progressive accumulation of AGEs and hence be a marker of long-term glucose exposure. Accordingly, relations with HbA1c from the previous 3-10 years have been established in both type 1 and type 2 diabetes, and even in gestational diabetes mellitus. Other important determinants of SAF exist however, notably age, renal function, diet, and genetics. SAF is also related to current and future micro- and macrovascular complications of diabetes, as expected for a marker of glycemic memory. It is also related to some important emerging diabetes complications and comorbidities such as cancer, cognitive decline and liver disease. Quantitative information on glucose exposure during the previous years may be pertinent to personnalize care for patients with diabetes: priority for glucose control when SAF is low, and for screening for complications once SAF is high.

Differential effect of pre-pregnancy low BMI on fetal macrosomia: a population-based cohort study

BACKGROUND

The differential effect of pre-pregnancy low BMI on macrosomia has not been fully addressed. Herein, we conducted a city-wide population-based cohort study to illuminate the association between pre-pregnancy low BMI and macrosomia, stratifying by maternal age, parity, and GDM status.

METHODS

All pregnant women who paid their first prenatal visit to the hospital in Qingdao during August 1, 2018, to June 30, 2020, were recruited to this study. The interactive effect of maternal age and pre-pregnancy low BMI on macrosomia was evaluated using logistic regression models, followed by strata-specific analyses.

RESULTS

A total of 105,768 mother-child pairs were included, and the proportion of fetal macrosomia was 11.66%. The interactive effect of maternal pre-pregnancy BMI and age was statistically significant on macrosomia irrespective of parity (nullipara: P_adjusted=0.0265; multipara: P_adjusted=0.0356). The protective effect of low BMI on macrosomia was most prominent among nullipara aged 35 years and above (aOR=0.16, 95% CI 0.05-0.49) and multipara aged 25 years and below (aOR=0.17, 95% CI 0.05-0.55). In nullipara without GDM, the risk estimates gradually declined with increasing conception age (20-to-24 years: aOR=0.64, 95% CI 0.51-0.80; 25-to-29 years: aOR=0.43 95% CI 0.36-0.52; 30-to-34 years: aOR=0.40 95% CI 0.29-0.53; and ≥35 years: aOR=0.19, 95% CI 0.06-0.60). A similar pattern could also be observed in nullipara with GDM, where the aOR for low BMI on macrosomia decreased from 0.54 (95% CI 0.32-0.93) in pregnant women aged 25-29 years to 0.30 (95% CI 0.12-0.75) among those aged 30-34 years. However, younger multiparous mothers, especially those aged 25 years and below without GDM (aOR=0.21, 95% CI 0.06-0.68), were more benefited from a lower BMI against the development of macrosomia.

CONCLUSIONS

Maternal low BMI is inversely associated with macrosomia irrespective of maternal age and parity. The impact of pre-pregnancy low BMI on macrosomia varied by maternal age and parity. The protective effect of a lower maternal BMI against fetal macrosomia was more prominent in nulliparous mothers aged 35 years and above, whereas multiparous mothers younger than 25 years of age were more benefited.