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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials. Am J Perinatol 2024. [PMID: 38134941 DOI: 10.1055/a-2234-7980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Infants born large for gestational age (LGA) are at an increased risk of short- and longer-term adverse outcomes. Understanding fetal growth and adiposity and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth. STUDY DESIGN This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials-the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal body mass index (BMI) ranged from 18.5 to ≥40.0 kg/m2. Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks' gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity. RESULTS Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks' gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI. CONCLUSION Infants born LGA had larger fetal biometry measures at all time points from 20 weeks' gestation, compared with infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy or prior to conception. KEY POINTS · Infants born LGA had larger fetal biometry measures from 20 weeks' gestation.. · Infants born LGA had larger fetal adiposity measures.. · Interventions to prevent LGA need to start earlier in pregnancy or prior to conception..
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Affiliation(s)
- Amanda J Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health; Adelaide, South Australia, Australia
| | - Andrea R Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
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Sabir MS, Hassan MM, Malik M, Saleem R, Tariq Z, Zohaib K, Javaid M, Malik AY, Saleem A. Diagnostic Accuracy of Fetal Anterior Abdominal Wall Thickness as an Early Sonographic Sign for Diagnosing Gestational Diabetes. Cureus 2023; 15:e46538. [PMID: 37927742 PMCID: PMC10625453 DOI: 10.7759/cureus.46538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Traditionally, different fetal variable measurements are used in ultrasound to assess fetal growth. Ultrasound can detect abnormal fetal growth. Gestational diabetes mellitus (GDM) is linked to higher fetal obesity as early as 20 weeks of pregnancy. The amount of fetal adipose tissue may be measured by measuring the thickness of the anterior abdominal wall. Measuring the thickness of the fetus's anterior abdominal wall (AAWT) is a straightforward procedure that may be performed alongside standard abdominal circumference measurements. Objectives To check the diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, keeping oral glucose tolerance test as the gold standard. Study design This research was conducted using a cross-sectional analysis. Study place and duration The study was conducted in the Radiology Department at Rawalpindi Medical University and Allied Hospitals from July 10, 2019 to January 9, 2020. Materials and methods Women between the ages of 18 and 45 who had a family history of type 2 diabetes and were at risk for developing GDM were recruited. Exclusions were made for diabetic women, those carrying multiples, and those with autoimmune diseases. The AAWT measurement of the fetus, which included the skin and subcutaneous tissue, was acquired using the traditional anterior cranial view, 2-3 cm lateral to cord insertion. Pregnant patients at risk for GDM underwent screening using an oral glucose tolerance test. Those exhibiting any two abnormal values were diagnosed with GDM. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, with the oral glucose tolerance test as the gold standard, were 93.14%, 82.65%, 84.82%, 92.05%, and 88.0%, respectively. Conclusion The study concludes that the diagnostic accuracy of fetal AAWT as an early sonographic indicator for identifying gestational diabetes is notably high.
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Affiliation(s)
| | | | - Moeena Malik
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Rabia Saleem
- Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Zartasha Tariq
- General Medicine, Holy Family Hospital Rawalpindi, Rawalpindi, PAK
| | - Khurram Zohaib
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Maham Javaid
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Adnan Younas Malik
- Internal Medicine and Nephrology, District Headquarter Hospital, Rawalpindi, PAK
| | - Amna Saleem
- Pediatrics and Child Health, Islamic International Medical College Trust (IIMCT)Pakistan Railways Hospital, Rawalpindi, PAK
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Wang J, Cheng X, Li ZH, Mao YC, Wang XQ, Zhang KD, Yu WJ, Li YQ, Zhao JW, Chen ML, Gao GP, Hu CY, Zhang XJ. The effects of gestational diabetes mellitus on fetal growth: is it different for low-risk and medium-high-risk pregnant women? Arch Gynecol Obstet 2023:10.1007/s00404-023-07229-9. [PMID: 37773466 DOI: 10.1007/s00404-023-07229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND It has been suggested that gestational diabetes mellitus (GDM) alters the growth trajectory of a fetus and increases the risk of abnormal birth weight. In spite of this, there is still a significant debate regarding the mode and optimal timing of diagnosing this condition. Our aim was to determine fetal growth velocity and birth biometry in pregnant women with GDM at varying risk levels. METHODS We conducted a cohort study involving 1023 pregnant women at a maternity hospital in Ma'anshan, China. All women completed an oral glucose tolerance test at 24-28 weeks' gestation. We measured fetal head circumference (HC), femoral length (FL), abdominal circumference (AC), biparietal diameter (BPD), and estimate fetal weight (EFW) by ultrasound at 17, 24, 31, and 35 weeks' gestation, respectively. RESULTS Overall, 5115 ultrasound scans were performed. Among both low-risk and medium-high-risk pregnant women at 17-24 weeks' gestation, GDM exposure was associated with an increase in fetal growth velocity. Neonates born to women with GDM at medium-high risk had significantly larger birth weights than those born to women without GDM, while this was not observed in women at low risk. CONCLUSION In medium-high-risk pregnant women, exposure to GDM has a greater effect on the fetus, leading to abnormal fetal growth velocity that lasts beyond week 24. It is evident from our results that the effects of GDM on fetal growth differ between medium-high-risk pregnant women and low-risk pregnant women, and therefore a different screening program based on the risk factor for GDM is warranted.
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Affiliation(s)
- Jie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhen-Hua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yi-Cheng Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kang-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Wen-Jie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Ying-Qing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jia-Wen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Mao-Lin Chen
- Department of Gynecology and Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Guo-Peng Gao
- Department of Gynecology and Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
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Seth I, Aiyappan RK, Singh S, Seth A, Sharma D, K JM, Krishnan V, Seth A, Yadav CM, Jain H. Mid-Trimester Fetal Anterior Abdominal Wall Subcutaneous Tissue Thickness: An Early Ultrasonographic Predictor of Gestational Diabetes Mellitus. Cureus 2023; 15:e34610. [PMID: 36891019 PMCID: PMC9985981 DOI: 10.7759/cureus.34610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to determine whether mid-trimester fetal anterior abdominal wall subcutaneous tissue thickness (FASTT) is an early sonographic predictor of gestational diabetes mellitus (GDM), as well as to study its correlation with maternal glycemic values on GDM screening at 24-28 weeks. Methodology We conducted a prospective, case-control study. FASTT was assessed at anomaly scan in 896 uncomplicated singleton pregnancies. The 75-gram oral glucose tolerance test (OGTT) was done for all included patients at 24-28 weeks. Women diagnosed with GDM were taken as cases and appropriately matched in equal numbers as controls. Statistical analysis was done using SPSS version 20 (IBM Corp., Armonk, NY, USA). Independent-samples t-test, chi-square test, receiver operating characteristic curve, and Pearson's correlation coefficient (r) were performed wherever applicable. Results A total of 93 cases and 94 controls were included. Fetuses of women with GDM had significantly higher mean FASTT at 20 weeks (1.605 ± 0.328 mm vs. 1.222 ± 0.121 mm; p < 0.001). The FASTT cut-off obtained was 1.35 mm (sensitivity = 79.6%, specificity = 87.2%, positive predictive value = 86%, negative predictive value = 81.2%). There was a moderate positive correlation between fasting blood sugar (FBS) and two-hour OGTT values and FASTT (r = 0.332, p < 0.001 and r = 0.399, p < 0.001, respectively). FASTT >1.35 mm had an independent predictive value for GDM and was associated with a 19.608-fold increased risk of GDM. Conclusions FASTT values greater than 1.35 mm at 20 weeks are associated with a significantly increased risk of GDM. In addition, FASTT correlates with FBS and two-hour OGTT at 24-28 weeks and is a simple predictor of GDM at 18-20 weeks.
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Affiliation(s)
- Isha Seth
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | | | - Sunayana Singh
- Obstetrics and Gynaecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Aditya Seth
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Deepti Sharma
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | - Janu M K
- Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Kochi, IND
| | - Vivek Krishnan
- Perinatology and Foetal Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Arushi Seth
- Medicine, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Chander Mohan Yadav
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Harsh Jain
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Kim HS, Oh SY, Cho GJ, Choi SJ, Hong SC, Kwon JY, Kwon HS. A Predictive Model for Large-for-Gestational-Age Infants among Korean Women with Gestational Diabetes Mellitus Using Maternal Characteristics and Fetal Biometric Parameters. J Clin Med 2022; 11:jcm11174951. [PMID: 36078881 PMCID: PMC9456704 DOI: 10.3390/jcm11174951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: With increasing incidence of gestational diabetes mellitus (GDM), newborn infants with perinatal morbidity, including large-for-gestational-age (LGA) or macrosomia, are also increasing. The purpose of this study was to develop a prediction model for LGA infants with GDM mothers. Methods: This was a retrospective case-control study of 660 women with GDM and singleton pregnancies in four tertiary care hospitals from 2006 to 2013 in Korea. Biometric parameters were obtained at diagnoses of GDM and within two weeks before delivery. These biometric data were all transformed retrospectively into Z-scores calculated using a reference. Interval changes of values between the two periods were obtained. Multivariable logistic and stepwise backwards regression analyses were performed to develop the most parsimonious predictive model. The prediction model included pre-pregnancy body mass index (BMI), head circumference (HC), Z-score at 24 + 0 to 30 + 6 weeks’ gestation, and abdominal circumference (AC) Z-score at 34 + 0 to 41 + 6 weeks within 2 weeks before delivery. The developed model was then internally validated. Results: Our model’s predictive performance (area under the curve (AUC): 0.925) was higher than estimated fetal weight (EFW) within two weeks before delivery (AUC: 0.744) and the interval change of EFW Z-score between the two periods (AUC: 0.874). It was internally validated (AUC: 0.916). Conclusions: A clinical model was developed and internally validated to predict fetal overgrowth in Korean women with GDM, which showed a relatively good performance.
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Affiliation(s)
- Hee-Sun Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Soo-Young Oh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Geum Joon Cho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea
| | - Suk-Joo Choi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soon Cheol Hong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul 02841, Korea
| | - Ja-Young Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea
| | - Han Sung Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University School of Medicine 120-1, Neungdongno, Gwangjin-gu, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-7645; Fax: +82-2-2030-7748
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Lewis R, Gupta C, Punja R. Comparison of anthropometric measurements of foetuses in normal, gestational diabetes-affected, and hypertensive pregnancies. J Taibah Univ Med Sci 2021; 16:887-893. [PMID: 34899134 PMCID: PMC8626796 DOI: 10.1016/j.jtumed.2021.08.004] [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: 04/03/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Foetal anthropometry evaluates and monitors foetal development and assesses the nutritional state of the developing foetus. It is a vital indicator of the normalcy of foetal development in-utero. The most relevant parameters in foetal anthropometry are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Gestational diabetes mellitus (GDM) and gestational hypertension (GHTN) are the major reasons for variations in foetal development. In this study, we compare foetal anthropometric measurements taken using ultrasounds of normal, gestational diabetes-affected, and hypertensive pregnancies. METHOD In this study, a total of 615 anomaly scans were done between the gestational ages of 18-22 weeks from 2016 to 2018. The patients' data were collected from the register of the anomaly scanning room. The foetal anthropometric parameters measured BPD, HC, AC, and FL. RESULTS All the measurements including BPD, HC, and AC were lower in foetuses affected by GHTN, and all the measurements, including FL, were higher in foetuses affected by GDM than in normal pregnancies. A post-hoc analysis using Tukey's test showed that each foetal parameter had a significant correlation with pregnancy-related co-morbidities (p-value < 0.05). CONCLUSION It is clear from our study that the foetuses of mothers with GDM showed a consistent variation of 10 mm above the normal average in terms of the BPD, HC, AC, and FL measurements. The GHTN-affected foetuses had averages that were lower than normal for BPD, HC, and AC.
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Affiliation(s)
- Rhea Lewis
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chandni Gupta
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Rohini Punja
- Department of Anatomy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Zhou J, Xiong Y, Ren Y, Zhang Y, Li X, Yan Y. Three-dimensional power Doppler ultrasonography indicates that increased placental blood perfusion during the third trimester is associated with the risk of macrosomia at birth. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:12-19. [PMID: 32964472 DOI: 10.1002/jcu.22912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 12/12/2019] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the association between placental blood perfusion and the occurrence of macrosomia at birth. METHODS This was a prospective cohort study including women with singleton pregnancies that aimed to measure placental blood perfusion using three-dimensional (3D) power Doppler ultrasonography in the second and third trimester. We acquired three indices of placental blood flow, including vascularization index (VI), flow index (FI), vascularization flow index (VFI), along with routine two-dimensional (2D) biometric measurements, including abdominal circumference (AC) and estimated fetal weight (EFW). Pregnancy outcomes were divided into two groups: newborns with a normal birth weight and those with macrosomia. We then compared all of the recorded variables between these two groups. We also determined the predictive efficiency of each variable using receiver-operating characteristic (ROC) curves. RESULTS The placental 3D power Doppler indices, including VI and FI, were significantly higher in the third trimester of pregnancies developing macrosomia, but not during the second trimester, as compared to those with a normal birth weight. ROC curves analysis for third-trimester VI and FI suggested a slight ability to predict macrosomia; this was also the case for AC and EFW. Interestingly, VI showed high sensitivity and low specificity, while FI showed low sensitivity and high specificity; this was also the case for AC and EFW. CONCLUSIONS Three-dimensional power Doppler ultrasound indices were significantly higher during the third-trimester for pregnancies developing macrosomia. However, these indices had only moderate ability to predict macrosomia.
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Affiliation(s)
- Jizi Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yu Xiong
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yunyun Ren
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yingliu Yan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Hosseini E, Janghorbani M, Shahshahan Z. Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy. Midwifery 2018; 66:64-69. [PMID: 30130677 DOI: 10.1016/j.midw.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare risk factors and pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed during early and late pregnancy. DESIGN Prospective population-based cohort study. SETTING Community health care centers of Isfahan, Iran. PARTICIPANTS AND MEASUREMENTS 1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6-14 weeks). The women free from GDM or overt diabetes were screened at 24-28 weeks of gestation using a 75-g, 2-hour oral glucose tolerance test. The diagnosis of GDM was reached through the International Association of the Diabetes and Pregnancy Study Groups. Early-onset GDM was defined as the diagnosis of GDM at the first prenatal visit. Late-onset GDM was defined as the diagnosis of GDM later at 24-28 weeks. FINDINGS Prevalence of GDM was 10% (95% CI: 8.1-11.9) at the first prenatal visit. GDM incidence was 9.3% (95% CI: 7.4-11.2) at 24-28 weeks of gestation. Family history of diabetes, and previous gestational diabetes and maternal age were the independent risk factors for GDM during early and late diagnosis. GDM was associated with increased risk of macrosomia, large for gestational age, and cesarean section in both periods while, neonates of women with early-onset GDM were more likely to have an apgar score at 1-min < 7, and neonatal respiratory distress syndrome and were more admitted to the neonatal intensive care unit. KEY CONCLUSION AND IMPLICATION FOR PRACTICE Despite early screening and current practice management, early-onset GDM was associated with poorer pregnancy outcomes compared to the late-onset group. Women with early-onset GDM would benefit from more strict surveillance and management strategies to improve pregnancy outcomes. Further studies are needed to evaluate the efficacy of alternative management approaches in these high risk women.
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Affiliation(s)
- Elham Hosseini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Janghorbani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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McGrath RT, Glastras SJ, Hocking SL, Fulcher GR. Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia. Diabetes Care 2018; 41:1821-1828. [PMID: 30030258 DOI: 10.2337/dc18-0551] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia .,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Central Clinical School and The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
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Ring S, Glastras SJ, Hocking SL, Seeho SK, Scott ES, Fulcher GR, McGrath RT. Excess foetal growth and glycaemic control in type 1 diabetes and pregnancy. DIABETES & METABOLISM 2018; 45:497-499. [PMID: 29398256 DOI: 10.1016/j.diabet.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- S Ring
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - S J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia; Kolling Institute, St-Leonards, NSW, Australia
| | - S L Hocking
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - S K Seeho
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St-Leonards, NSW, Australia
| | - E S Scott
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia
| | - G R Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - R T McGrath
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia; Kolling Institute, St-Leonards, NSW, Australia.
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Growth and BMI during the first 14 y of life in offspring from women with type 1 or type 2 diabetes mellitus. Pediatr Res 2017; 81:342-348. [PMID: 27828938 DOI: 10.1038/pr.2016.236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/30/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Infants of women with pregestational diabetes are at risk for developing obesity in later life. This study aimed to identify subgroups at highest risk, by studying growth profiles of offspring from women with type 1 or 2 diabetes mellitus (ODM1, ODM2) until the age of 14 y. METHODS Information from infant welfare centers was received for 78 ODM1 and 44 ODM2. Mean BMI SD scores (SDS) (based on 1980 nation-wide references) and height SDS (based on 2009 references) were calculated and included in a random-effects model. Values were compared to the 2009 Dutch growth study. RESULTS BMI SDS profiles differed between ODM1 and ODM2, with the highest mean BMI SDS profiles in ODM2. Other factors that affected growth profiles in these infants included the presence of maternal obesity, large for gestational age (LGA) at birth and in ODM2 a Dutch-Mediterranean origin. CONCLUSION Offspring of women with diabetes have higher BMI SDS profiles than observed in the 2009 Dutch growth study, with the highest BMI SDS in ODM2 who are LGA at birth and have obese mothers. Preventive strategies for offspring adiposity may include pursuing lower prepregnancy maternal BMI, prevention of LGA at birth, and prevention of increased weight gain during childhood.
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12
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Paddock M, Akram R, Jarvis DA, Armitage P, Song S, Madhuvrata P, Griffiths PD. The assessment of fetal brain growth in diabetic pregnancy using in utero magnetic resonance imaging. Clin Radiol 2017; 72:427.e1-427.e8. [PMID: 28057322 DOI: 10.1016/j.crad.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/24/2016] [Accepted: 12/07/2016] [Indexed: 02/04/2023]
Abstract
AIM To assess fetal brain growth over the third trimester in pregnant women with diabetes using in utero magnetic resonance imaging (iuMRI) to determine if greater brain growth occurs in type 1 (T1DM) when compared to gestational (GDM) diabetes mellitus. MATERIALS AND METHODS Each consented participant was scanned at three fixed times during the third trimester using iuMRI. One hundred and fifty-seven patients were approached, 48 participants were recruited, and 36 complete data sets were analysed. Three-dimensional (3D) iuMRI volume data sets were manually segmented using software to construct models of the fetal brain from which brain volumes could be calculated. Inter-rater analysis was performed, and volume differences and growth rates were compared between T1DM and GDM. RESULTS Recruitment proved difficult with low uptake and high attrition rates (77.1%). Inter-rater analysis revealed excellent correlation (intraclass correlation coefficient=0.93, p<0.001) and agreement with no significant difference between operators (p=0.194). There was no evidence of increased brain volume in the T1DM group. Growth rates between visit 1 and 3 for T1DM and GDM were not significantly different (p=0.095). CONCLUSION T1DM brain volumes were not significantly larger than GDM volumes and there was no significant divergence of brain growth over the third trimester. Constructing volume models from 3D iuMRI acquisitions is a novel technique that can be used to assess fetal brain growth. No specialist software or knowledge is required. Larger studies attempting to recruit pregnant women in the later stages of pregnancy should employ multicentre recruitment to overcome recruitment difficulties and high attrition rates.
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Affiliation(s)
- M Paddock
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - R Akram
- The Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - D A Jarvis
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - P Armitage
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - S Song
- Department of Diabetes and Endocrinology, Northern General Hospital, Sheffield S5 7AU, UK
| | - P Madhuvrata
- Department of Obstetrics & Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - P D Griffiths
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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13
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Hammoud NM, de Valk HW, Biesma DH, Visser GHA. Intrauterine Adiposity and BMI in 4- to 5-Year-Old Offspring from Diabetic Pregnancies. Neonatology 2017; 111:177-181. [PMID: 27788515 PMCID: PMC5296881 DOI: 10.1159/000448681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/24/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pregnancies complicated by maternal diabetes are associated with disproportionate intrauterine growth that subsequently may lead to pediatric adiposity. OBJECTIVES We investigated whether disproportionate intrauterine growth leads to differences in BMI in 4- to 5-year-old offspring from pregnancies complicated by type 1 (ODM1), type 2 (ODM2), or gestational diabetes (OGDM). METHODS Ultrasound data of fetal head-to-abdominal circumference (HC/AC) ratio obtained between 32 and 36 weeks of gestational age were related to offspring anthropometrics that were retrieved from infant welfare centers. RESULTS Data from 27 ODM1, 22 ODM2, and 24 OGDM were obtained. Ultrasound measurements for the HC/AC ratio were performed at a mean of 33-34 weeks, with a mean Z-score of the HC/AC ratio of -0.801, -0.879, and 0.017 in ODM1, ODM2, and OGDM. Mean BMI SDS was highest in ODM2 as compared to ODM1 and OGDM. In ODM1 there was a negative correlation between HC/AC ratio and BMI SDS at the ages of 4 and 5 years, but not in ODM2 or OGDM. The birth weight Z-score was positively correlated to BMI SDS in ODM2 and OGDM. CONCLUSION Disproportionate intrauterine growth, expressed as the HC/AC ratio, was inversely related with BMI SDS in ODM1 at the ages of 4-5 years, but not in ODM2 or OGDM. Weight and maybe obesity in ODM1 offspring are likely to be related to intrauterine adiposity, whereas overweight in ODM2 and OGDM offspring seems more related to other factors such as birth weight centile, maternal obesity, and altered lifestyle factors during childhood.
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Affiliation(s)
- Nurah M Hammoud
- Division Woman & Baby, Department of Obstetrics, The University Medical Center Utrecht, Utrecht, The Netherlands
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14
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O'brien CM, Poprzeczny A, Dodd JM. Implications of maternal obesity on fetal growth and the role of ultrasound. Expert Rev Endocrinol Metab 2017; 12:45-58. [PMID: 30058877 DOI: 10.1080/17446651.2017.1271707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over fifty percent of women entering pregnancy are overweight or obese. This has a significant impact on short and long term maternal and infant health outcomes, and the intergenerational effects of obesity are now a major public health problem globally. Areas covered: There are two major pathways contributing to fetal growth. Glucose and insulin directly affect growth, while other substrates such as leptin, adiponectin and insulin-like growth factors indirectly influence growth through structural and morphological effects on the placenta, uteroplacental blood flow, and regulation of placental transporters. Advances in ultrasonography over the past decade have led to interest in the prediction of the fetus at risk of overgrowth and adiposity utilizing both standard ultrasound biometry and fetal body composition measurements. However, to date there is no consensus regarding the definition of fetal overgrowth, its reporting, and clinical management. Expert commentary: Maternal dietary intervention targeting the antenatal period appear to be too late to sufficiently affect fetal growth. The peri-conceptual period and early pregnancy are being evaluated to determine if the intergenerational effects of maternal obesity can be altered to improve newborn, infant and child health.
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Affiliation(s)
- Cecelia M O'brien
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- b Maternal Fetal Medicine Unit , John Hunter Hospital , Newcastle , Australia
| | - Amanda Poprzeczny
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- c Department of Obstetrics and Gynaecology , Lyell McEwin Hospital , Adelaide , Australia
| | - Jodie M Dodd
- a School of Paediatrics and Reproductive Health, and Robinson Research Institute , University of Adelaide , Adelaide , Australia
- d Department of Perinatal Medicine, Women's and Babies Division , Women's and Children's Hospital , Adelaide , Australia
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15
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Grivell RM, Yelland LN, Deussen A, Crowther CA, Dodd JM. Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial. BJOG 2016; 123:233-43. [PMID: 26841216 DOI: 10.1111/1471-0528.13777] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report the influence of maternal overweight and obesity on fetal growth and adiposity and effects of an antenatal dietary and lifestyle intervention among these women on measures of fetal growth and adiposity as secondary outcomes of the LIMIT Trial. DESIGN Randomised controlled trial. SETTING Public maternity hospitals in metropolitan Adelaide, South Australia. POPULATION Pregnant women with a body mass index ≥ 25 kg/m(2), and singleton gestation between 10(+0) and 20(+0) weeks. METHODS Women were randomised to Lifestyle Advice or continued Standard Care and offered two research ultrasound scans at 28 and 36 weeks of gestation. MAIN OUTCOME MEASURES Ultrasound measures of fetal growth and adiposity. RESULTS For each fetal body composition parameter, mean Z-scores were substantially higher when compared with population standards. Fetuses of women receiving Lifestyle Advice demonstrated significantly greater mean mid-thigh fat mass, when compared with fetuses of women receiving Standard Care (adjusted difference in means 0.17; 95% CI 0.02-0.32; P = 0.0245). While subscapular fat mass increased between 28 and 36 weeks of gestation in fetuses in both treatment groups, the rate of adipose tissue deposition slowed among fetuses of women receiving Lifestyle Advice, when compared with fetuses of women receiving Standard Care (P = 0.0160). No other significant differences were observed. CONCLUSIONS These findings provide the first evidence of changes to fetal growth following an antenatal dietary and lifestyle intervention among women who are overweight or obese.
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Affiliation(s)
- R M Grivell
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
| | - L N Yelland
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - A Deussen
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - C A Crowther
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - J M Dodd
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
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16
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Sweeting AN, Ross GP, Hyett J, Molyneaux L, Constantino M, Harding AJ, Wong J. Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment. Diabetes Care 2016; 39:75-81. [PMID: 26645084 DOI: 10.2337/dc15-0433] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/06/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent guidelines recommend testing at <24 weeks of gestation for maternal dysglycemia in "high-risk" women. Evidence to support the early identification and treatment of gestational diabetes mellitus (GDM) is, however, limited. We examined the prevalence, clinical characteristics, and pregnancy outcomes of high-risk women with GDM diagnosed at <24 weeks of gestation (early GDM) and those with pre-existing diabetes compared with GDM diagnosed at ≥24 weeks of gestation, in a large treated multiethnic cohort. RESEARCH DESIGN AND METHODS Outcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at <12 weeks of gestation (n = 68), at 12-23 weeks of gestation (n = 1,247), or at ≥24 weeks of gestation (n = 3,493). RESULTS Hypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at <12 weeks of gestation were comparable to rates seen in women with pre-existing diabetes. CONCLUSIONS Despite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.
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Affiliation(s)
- Arianne N Sweeting
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Glynis P Ross
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Jon Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Lynda Molyneaux
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Constantino
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anna Jane Harding
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Aksoy H, Aksoy Ü, Yücel B, Saygi Özyurt S, Aydın T, Alparslan Babayiğit M. Fetal anterior abdominal wall thickness may be an early ultrasonographic sign of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2015; 29:2028-32. [DOI: 10.3109/14767058.2015.1072164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Secher AL, Bytoft B, Tabor A, Damm P, Mathiesen ER. Fetal sonographic characteristics associated with shoulder dystocia in pregnancies of women with type 1 diabetes. Acta Obstet Gynecol Scand 2015; 94:1105-11. [PMID: 26178663 DOI: 10.1111/aogs.12707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/30/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder dystocia is a rare but severe complication of vaginal delivery and diabetic women are at high risk. The aim of this study was to identify fetal sonographic and maternal glycemic characteristics associated with shoulder dystocia in pregnant women with type 1 diabetes. MATERIAL AND METHODS Twelve cases (5%) of shoulder dystocia among 241 consecutive vaginal deliveries in women with type 1 diabetes followed at Rigshospitalet University Hospital in 2009-2013 were retrospectively identified in a local database. Fetal sonographic and clinical data were compared with 69 women with type 1 diabetes and uncomplicated vaginal deliveries. RESULTS Women experiencing shoulder dystocia compared with women with uncomplicated deliveries had a higher glycated hemoglobin (HbA1c) in early pregnancy [median 7.0% (range 5.9-8.1) vs. 6.6% (range 5.4-10.0, P = 0.04)], whereas in late pregnancy, HbA1c in the two groups of women was comparable [6.1% (range 5.5-6.9) vs. 6.0% (range 4.7-8.4, P = 0.30)]. Fetal biometry at 36 weeks showed a higher estimated fetal weight of 3597 g (range 3051-4069) vs. 2989 g (range 2165-4025), P < 0.001, corresponding to 20% (4-41%) vs. 5% (-20 to 44%) above the mean estimated fetal weight for gestational age (P = 0.002) and a greater abdominal circumference SD score of 2.51 (range 1.56-4.20) vs. 1.33 (range -1.08 to 4.25), P = 0.001). Head circumference was comparable. Vacuum extraction was more frequent during deliveries with shoulder dystocia (58 vs. 17%, P = 0.005). Seven (58%) newborns with shoulder dystocia had brachial plexus injuries, fractures, intra-abdominal bleeding or needed resuscitation. CONCLUSIONS Excessive estimated fetal weight and abdominal circumference at 36 weeks' sonographic examination may help in identifying diabetic women at high risk of later shoulder dystocia.
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Affiliation(s)
- Anna L Secher
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ann Tabor
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark.,Center of Fetal Medicine and Pregnancy, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Endocrinology, Rigshospitalet University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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19
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Schwartz RA, Simmonds LE, Rosenn B. Can a single preterm ultrasound accurately predict birth weight in gestational diabetes? J Matern Fetal Neonatal Med 2014; 29:8-11. [DOI: 10.3109/14767058.2014.991304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Hammoud NM, Visser GHA, Peters SAE, Graatsma EM, Pistorius L, de Valk HW. Fetal growth profiles of macrosomic and non-macrosomic infants of women with pregestational or gestational diabetes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:390-397. [PMID: 22744817 DOI: 10.1002/uog.11221] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess fetal growth profiles in an unselected group of pregnant women with either type-1 diabetes (DM1), type-2 diabetes (DM2) or gestational diabetes (GDM), with emphasis on intergroup differences and development of disproportionate fetal growth and macrosomia. METHODS Second- and third-trimester longitudinal ultrasound measurements of fetal growth were made in 77 women with DM1, 68 women with DM2 and in 99 women with GDM. Altogether 897 ultrasound examinations were performed and 145 uncomplicated pregnancies with 843 ultrasound examinations were included as controls. Ultrasound data included head circumference (HC), abdominal circumference (AC), femur length (FL) and HC/AC ratio. RESULTS The AC, but not HC and FL, evolved differently in diabetic pregnancies, with a smaller AC in early pregnancy and larger AC at term (significant for DM1 and DM2). The most striking differences were found for the HC/AC ratio, especially in DM1 pregnancies. HC/AC growth trajectories of both macrosomic and non-macrosomic fetuses differed from that of the controls, and the HC/AC ratio at term was lower in all diabetic subgroups except in non-macrosomic DM2 cases. CONCLUSION We found altered (disproportionate) fetal growth in macrosomic and non-macrosomic fetuses of women with DM1, DM2 and GDM. This indicates that the abnormal intrauterine environment affects the majority of these infants. Growth profiles differed among these groups, the most prominent growth deviations being found in the fetuses of women with DM1. The latter was most probably caused by poor glucose control. In monitoring fetal growth in diabetic pregnancies the HC/AC ratio should be used to assess altered fetal growth.
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Affiliation(s)
- N M Hammoud
- University Medical Center-Division of Woman and Baby, Utrecht, The Netherlands.
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21
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Nelson L, Wharton B, Grobman WA. Prediction of large for gestational age birth weights in diabetic mothers based on early third-trimester sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1625-1628. [PMID: 22123996 DOI: 10.7863/jum.2011.30.12.1625] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the ability of early third-trimester sonography to predict large for gestational age (LGA) birth weights in women with diabetes mellitus. METHODS We identified women with nonanomalous singleton gestations and pregestational and gestational diabetes mellitus who underwent sonographic examinations between gestational ages of 28 weeks and 32 weeks 6 days and subsequently delivered at 37 weeks or later. Using a cohort study design, we compared data from women with an estimated fetal weight at or above the 75th percentile (exposed group) with data from those with an estimated fetal weight below the 75th percentile (unexposed group). The primary outcome variable was LGA birth weight, defined as a birth weight of greater than 90% for gestational age. RESULTS Eighty-six women met inclusion criteria over a 3-year period: 40 were in the exposed group, and 46 were in the unexposed group. The mean body mass indices ± SD at delivery were similar for both groups: 35.4 ± 8.2 kg/m(2) exposed versus 35.0 ± 8.2 kg/m(2) unexposed (P = .80). There was no difference in the number of women with gestational diabetes mellitus: 40% exposed versus 39% unexposed (P = .90). Neonates whose early third-trimester estimated fetal weight was at or above the 75th percentile were significantly more likely to be LGA at birth compared with neonates whose early third-trimester estimated fetal weight was below the 75th percentile: 65% exposed versus 15% unexposed (P < .001; odds ratio, 10.3; 95% confidence interval, 3.7-29.1). There was no significant difference in cesarean delivery rates: 60% exposed versus 44% unexposed (P = .13) CONCLUSIONS Measurements obtained by early third-trimester sonographic fetal biometry are reasonably predictive of fetal LGA birth weights at term.
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Affiliation(s)
- Latasha Nelson
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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22
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Persson M, Pasupathy D, Hanson U, Norman M. Birth size distribution in 3,705 infants born to mothers with type 1 diabetes: a population-based study. Diabetes Care 2011; 34:1145-9. [PMID: 21430084 PMCID: PMC3114507 DOI: 10.2337/dc10-2406] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize birth size distribution in infants born to mothers with type 1 diabetes. In particular, the relationship between birth weight (BW) and length (BL) was studied because it may provide information on different causal pathways of fetal macrosomia commonly seen in diabetic pregnancies. RESEARCH DESIGN AND METHODS This was a population-based cohort study of 3,705 infants of type 1 diabetic mothers (1,876 boys), with a gestational age of 28-43 weeks, born in Sweden between 1998 and 2007. BW and BL were retrieved from the Medical Birth Registry and expressed as SD scores (SDS). Ponderal index (PI) was calculated as BW in g/length in cm³. A BW >90th and a PI ≤ 90th percentile was defined as proportionate large-for-gestational age (LGA), whereas if both BW and PI > 90th percentile, the infant was categorized as disproportionately large. Values are mean (SD). RESULTS The BW distribution for offspring of type 1 diabetic mothers was bell-shaped, significantly broader, and markedly shifted to the right (BWSDS: 1.27 [1.48]) of the reference. Of the infants born to diabetic mothers, 47% were LGA, and among them, 46% were disproportionately large compared with 35% in nondiabetic LGA infants (P < 0.001). Female offspring of type 1 diabetic mothers had significantly higher BWSDS than males (1.34 vs. 1.20, P < 0.01), and preterm infants had higher BWSDS than term infants (1.41 vs. 1.23, P < 0.01) CONCLUSIONS Fetal macrosomia in type 1 diabetic pregnancies is due to a right-shift and broadening of the entire BW distribution. The large number of disproportionate LGA infants born to type 1 diabetic mothers suggests an underlying metabolic problem. Fetal macrosomia was more pronounced in preterm and female offspring of type 1 diabetic mothers.
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Affiliation(s)
- Martina Persson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
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Mulder EJH, Koopman CM, Vermunt JK, de Valk HW, Visser GHA. Fetal growth trajectories in Type-1 diabetic pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:735-742. [PMID: 20521236 DOI: 10.1002/uog.7700] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe the individual intrauterine growth patterns of fetuses of insulin-dependent (Type-1) diabetic women and to examine determinants of overgrowth (macrosomia) and its timing. METHODS This retrospective longitudinal study examined the developmental trajectories of fetal abdominal circumference (AC) and biparietal diameter in 76 Type-1 diabetic women with singleton pregnancies. Latent class analysis was used to identify subgroups of patients with a shared fetal AC growth trajectory. Subsequently, maternal factors, including glycemic control as assessed by glycosylated hemoglobin (HbA1c), were examined to see whether they had any effect on fetal growth. RESULTS Four subgroups with different AC growth patterns were identified. Differences in birth weight between the distinct subgroups were related to the shape of the AC growth velocity curve over gestation. Acceleration of AC growth commencing before or after 25 weeks' gestation was associated with the birth of a heavy or large-for-dates baby in 94 and 56% of cases, respectively. Poor glycemic control (HbA1c > 7.0%) during the periconception period or before 12 weeks' gestation was a modest predictor of midtrimester growth in AC. Other diabetes-related factors, fetal sex, parity, or maternal weight/obesity were unrelated to the fetal growth pattern. CONCLUSION The findings suggest that an individual fetus's growth trajectory is set early in gestation and that the contemporaneous degree of maternal glycemia plays a role in determining birth weight.
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Affiliation(s)
- E J H Mulder
- Department of Perinatology and Gynecology, University Medical Centre, Utrecht, The Netherlands.
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24
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Aschwald CL, Catanzaro RB, Weiss EP, Gavard JA, Steitz KA, Mostello DJ. Large-for-gestational-age infants of type 1 diabetic mothers: an effect of preprandial hyperglycemia? Gynecol Endocrinol 2009; 25:653-60. [PMID: 19544119 DOI: 10.1080/09513590903015445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine how the frequency, timing and magnitude of hyperglycemia are associated with large-for-gestational-age (LGA) infants in pregnancies complicated by type 1 diabetes. METHODS Charts from pregnant women with type 1 diabetes (n = 70) were reviewed. Indices of maternal glycemic control were determined for seven gestational periods (weeks 7-10, 11-15, 16-19, 20-24, 25-28, 29-32 and 33-38) and compared between women who delivered LGA infants and appropriate-for-gestational-age (AGA) infants. RESULTS Of the 70 pregnancies, 57% of the infants were LGA (4.3 +/- 0.4 kg) and 43% were AGA (3.2 +/- 0.4 kg). Total maternal weight gain and rate of weight gain were significantly higher in mothers with LGA infants. The glycemic variables associated with an LGA infant were percentage of preprandial values above target for weeks 11-15, 25-28 and 29-32, and percentage of all values above target for weeks 33-38. For the entire pregnancy, the strongest predictors of an LGA infant were percentage of preprandial blood glucose values above target during weeks 29-32 and maternal weight gain. CONCLUSIONS In pregnant women with type 1 diabetes, frequent episodes of preprandial hyperglycemia in the third trimester significantly impact the development of LGA infants.
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Affiliation(s)
- Camille L Aschwald
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, Missouri, USA
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Ríos JM, Tufiño-Olivares E, Reza-López S, Sanín LH, Levario-Carrillo M. Birthweight percentiles by gestational age and gender for children in the North of Mexico. Paediatr Perinat Epidemiol 2008; 22:188-94. [PMID: 18298694 DOI: 10.1111/j.1365-3016.2007.00898.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to determine the 10th, 50th and 90th percentiles of birthweight, by gestational age and sex, for newborns covered by the Mexican Institute of Social Security (IMSS) in the State of Chihuahua. To generate the database, we used IMSS hospitals' records in the State of Chihuahua, covering the period between 1 January 2000 and 31 December 2004. We included singleton live births only, and excluded babies with congenital malformations. The birthweights of 88,368 children born at 21-44 weeks of gestation comprised our data. From these data, we calculated the 10th, 50th and 90th percentiles for each sex, at 32-44 weeks of gestation. The observed cutoffs for the 10th percentile in our population were 40-250 g higher than those reported in other references with Mexican populations. These results constitute an updated birthweight reference that will allow the identification of newborns in the North region of the country with low birthweight-for-gestational age. Such information can be a useful instrument for preventing or diminishing associated risks.
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Affiliation(s)
- Jesús Manuel Ríos
- Unidad de Investigación Médica en Epidemiología Clínica, Instituto Mexicano del Seguro Social en Chihuahua, Chihuahua, Mexico
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Ben-Haroush A, Chen R, Hadar E, Hod M, Yogev Y. Accuracy of a single fetal weight estimation at 29-34 weeks in diabetic pregnancies: can it predict large-for-gestational-age infants at term? Am J Obstet Gynecol 2007; 197:497.e1-6. [PMID: 17980186 DOI: 10.1016/j.ajog.2007.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 02/24/2007] [Accepted: 04/17/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study was undertaken to evaluate the accuracy of a single sonographic estimated fetal weight at 29-34 weeks' gestation with respect to birthweight determination in diabetic pregnancies. STUDY DESIGN A retrospective cohort study of 423 diabetic pregnancies with detailed fetal measurements at 29-34 weeks' gestation. Multivariate regression analysis was used to predict the birthweight. The percentiles of the estimated fetal weight and the calculated birthweight were compared with the actual birthweight percentile. RESULTS The mean birthweight percentile at term was significantly higher than the estimated fetal weight percentile at 29-34 weeks' gestation in the women with poor glycemic control, but not the women with good control. On multivariate analysis, the estimated fetal weight, interval from ultrasound to delivery, hemoglobin A1C level, gestational age at ultrasound, and classification of glycemic control were independently associated with the birthweight. Both the estimated fetal weight and the calculated birthweight had a low sensitivity and a low positive predictive value for predicting large-for-gestational-age infants. CONCLUSION Accelerated fetal growth is evident primarily in diabetic women with poor glycemic control. These fetuses cannot be identified by a single ultrasound examination at 29-34 weeks' gestation.
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Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care 2007; 30 Suppl 2:S200-5. [PMID: 17596472 DOI: 10.2337/dc07-s216] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Siri L Kjos
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California, USA.
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Mirghani H, Zayed R, Thomas L, Agarwal M. Gestational diabetes mellitus: fetal liver length measurements between 21and 24 weeks' gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:34-7. [PMID: 17152075 DOI: 10.1002/jcu.20294] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To evaluate sonographic measurements of the fetal liver, fetal abdominal fat layer, interventricular septum, and Wharton's jelly area between 21 and 24 weeks' gestation in women with gestational diabetes mellitus (GDM). METHODS A total of 123 consecutive healthy pregnant women underwent sonographic examination at 21-24 weeks' gestational age. The measurements included fetal biometry, detailed anomaly scan, and fetal body composition measurements (subcutaneous fat, liver size, cardiac muscle thickness, and Wharton's jelly area). GDM was confirmed by way of a 75-g oral glucose tolerance test using World Health Organization criteria within 1 week of the examination. RESULTS Nineteen (15.4%) women were diagnosed with GDM, while 104 (84.6%) women were without GDM. The mean fetal liver length was 36 mm (95% CI 32-37) in women with GDM and 31 mm (95% CI 30-33) in women without GDM (p < 0.01). Liver enlargement was related to maternal fasting glucose levels and not 2-hour postprandial levels. There was no significant difference in the fetal biometric and other fetal body measurements between the 2 groups. CONCLUSIONS The findings of this study suggest that midtrimester fetal liver length appears to be longer in GDM than in normal pregnancies. However, the fetal abdominal fat layer, interventricular septum, and Wharton's jelly were not affected. Nevertheless, further, larger randomized studies are required to confirm these findings.
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Affiliation(s)
- Hisham Mirghani
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirate University, United Arab Emirates
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Wong SF, Lee-Tannock A, Amaraddio D, Chan FY, McIntyre HD. Fetal growth patterns in fetuses of women with pregestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:934-8. [PMID: 17083144 DOI: 10.1002/uog.3831] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To assess the effect of glucose control on the rate of growth of fetuses in women with pregestational diabetes mellitus (Types 1 and 2). METHODS All pregestational diabetic women booked at Mater Mothers' Hospital, Brisbane, Australia, between 1 January 1994 and 31 December 2002, were included. Pregnancies with congenital fetal anomalies, multiple pregnancies, and pregnancies terminated prior to 20 weeks' gestation were excluded. Dating scans were performed before 14 weeks' gestation and serial scans were performed at 18, 24, 28, 32 and 36 weeks. Fetal parameters, including biparietal diameter, femur length and abdominal circumference, were recorded. The daily growth rates for biparietal diameter, femur length, and fetal abdominal area were calculated and compared with those in a low-risk (non-diabetic) population. The growth rates in fetuses of women with satisfactory diabetic control (HbA1c < 6.5%) and unsatisfactory control (HbA1c > or = 6.5%) in the three trimesters were compared. RESULTS A total of 174 diabetic pregnancies were included and a total of 997 ultrasound scans were performed. The growth rates for fetuses of mothers with diabetes mellitus were significantly higher than for those in the low-risk population. The z-scores for biparietal diameter, femur length, and fetal abdominal area were 0.18, 0.59 and 1.44, respectively. Fetuses of diabetic mothers with high HbA1c in the first trimester had significantly greater fetal abdominal area growth rate than those with normal HbA1c (fetal abdominal area z-score of 1.7 vs. 0.75, P = 0.009). Although the fetal abdominal area z-scores in fetuses of diabetic mothers with high HbA1c in the second or third trimesters were also higher than those with normal HbA1c levels, the differences did not reach statistical significance. Maternal obesity did not influence the fetal growth rate. CONCLUSION The rate of growth of fetuses of diabetic mothers differs from that of the normal population. Growth acceleration persists until the late third trimester. Moreover, periconceptional glucose control appears to have a significant effect on accelerated growth of the fetal abdominal area.
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Affiliation(s)
- S F Wong
- Maternal Fetal Medicine Unit, Department of Obstetrics & Gynaecology, University of Queensland, South Brisbane, Queensland, Australia.
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Padmanabhan R, Mohamed S, Singh S. Beneficial Effect of Supplemental Lipoic Acid on Diabetes-Induced Pregnancy Loss in the Mouse. Ann N Y Acad Sci 2006; 1084:118-31. [PMID: 17151296 DOI: 10.1196/annals.1372.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Uncontrolled diabetes mellitus (DM) is an etiological factor for recurrent pregnancy loss, fetal growth disorders, and major congenital malformations in the offspring. Antioxidant therapy has been advocated to overcome the oxidant-antioxidant disequilibrium inherent in diabetes. The objective of this article was to evaluate the beneficial effects of alpha-lipoic acid (LA) on fetal outcome in a mouse model of streptozotocin (STZ)-induced DM. Timed pregnant mice were made diabetic by intraperitoneal (IP) injection of a single dose of STZ (200 mg/kg) on gestation day (GD) 2. Diabetic animals were supplemented daily with an IP injection of 15 mg/kg of LA starting on GD 4 and continued through GD 12. Fetuses were examined on GD 18 for malformations and growth restriction. Some diabetic mice injected with Evans blue were examined on GD 3.5 and GD 6.5 to evaluate frequency of implantations. STZ-treated mice had all cardinal signs of DM. LA treatment did not normalize blood glucose levels of DM mice. Rates of pregnancy in saline control, DM, and DM + LA groups were 90%, 28%, and 64%, respectively, indicating that LA promotes pregnancy in DM animals. However, postimplantation resorption showed a threefold increase in the DM + LA group. Rates of intrauterine growth restriction and major congenital malformations were also augmented thus indicating that the interaction between DM and LA has deleterious effects on postimplantation embryos.
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Affiliation(s)
- Rengasamy Padmanabhan
- Department of Anatomy, Faculty of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates.
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Zorić S, Micić D, Kendereski A, Sumarac-Dumanović M, Cvijović G, Pejković D, Cvetković M, Ljubić A, Dukanac-Stamenković J. [Use of continuous subcutaneous insulin infusion by a portable insulin pump during pregnancy in women with type 1 diabetes mellitus]. VOJNOSANIT PREGL 2006; 63:648-51. [PMID: 16875425 DOI: 10.2298/vsp0607648z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. METHODS A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated--HbAlc, mean blood glucose value in daily profiles--MBG, daily requirement for insulin--IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. RESULTS There was a significant improvement in HbA1c (8.94 +/- 1.62 vs. 6.90 +/- 1.22 %,p < 0.05), MBG (9.23 +/- 2.22 vs. 6.41 +/- 1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66 +/- 0.22 vs. 0.55 +/- 0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbAlc (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated. CONCLUSIONS There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.
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Affiliation(s)
- Svetlana Zorić
- Klinicki centar Srbije, Institut za endokrinologiju, dijabetes i bolesti metabolizma, Beograd.
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Sacks DA, Liu AI, Wolde-Tsadik G, Amini SB, Huston-Presley L, Catalano PM. What proportion of birth weight is attributable to maternal glucose among infants of diabetic women? Am J Obstet Gynecol 2006; 194:501-7. [PMID: 16458653 DOI: 10.1016/j.ajog.2005.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 06/21/2005] [Accepted: 07/06/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was undertaken to determine the proportion of birth weight attributable to glucose concentrations of diabetic mothers. STUDY DESIGN Data of diabetic women who used insulin were eligible for analysis if the women had been treated during pregnancy for at least 12 weeks, and had recorded at least 50% of 4 daily glucose checks (fasting and 1-hour postprandial) until the last office visit before delivery. The independent association between maternal glucose values and demographics and birth weight percentiles for gestational age and gender were analyzed by multiple regression methods. RESULTS Data of 90 diabetic women were analyzed. Only third-trimester glucose concentrations were associated with birth weight. Prepregnancy body mass index was also selected in the models, including second- and/or third-trimester glucose. Together, these variables explained 18% of the variance in birth weight percentiles. CONCLUSION Maternal glycemia during third-trimester and prepregnancy body mass index are independent predictors of birth weight in pregnancies complicated by insulin-requiring gestational or type 2 diabetes.
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Affiliation(s)
- David A Sacks
- Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, CA, USA
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Abstract
Despite significantly increased input from multidisciplinary teams during the antenatal period, pregnancy outcomes for women with type 1 and type 2 diabetes remain substantially worse than that of the general obstetric population. Regarding fetal congenital malformations, these are likely to be preventable only by strategies introduced prior to pregnancy. The relationship between fetal macrosomia and glycaemic control is complex, and reducing the incidence of macrosomia may be possible only by novel management strategies that address the wide fluctuations in blood glucose over a 24-hour period. Irrespective of pregnancy diabetes control, the complication of neonatal hypoglycaemia can largely be avoided by tight control of glucose values during labour and delivery. The continued lack of understanding of the pathophysiology of late fetal death in diabetic pregnancies and the shortcomings of current methods of antenatal fetal surveillance make it likely that infants of diabetic mothers will continue to be delivered preterm, with the attendant implications of neonatal morbidity and cost.
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Affiliation(s)
- Stephen A Walkinshaw
- Consultant in Maternal and Fetal Medicine, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
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Abstract
UNLABELLED Type 1 diabetes in pregnancy can result in significant short- and long-term morbidity to both mother and offspring if management is suboptimal. This morbidity imposes a considerable financial and health burden on the individual and society at large. There is currently a significant body of knowledge to offer guidance on optimal obstetric management of the woman with type 1 diabetes. Utilization of appropriate management guidelines preconception and during pregnancy is an effective strategy to limit complications of type 1 diabetes and should therefore become the standard of care. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to describe the features of a type I diabetic patient, to outline the goals of preconception care in this population of patients, to list the potential adverse effects of diabetes in pregnancy, and to summarize a potential strategy for the management of insulin administration in pregnancy.
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Lampl M, Jeanty P. Exposure to maternal diabetes is associated with altered fetal growth patterns: A hypothesis regarding metabolic allocation to growth under hyperglycemic-hypoxemic conditions. Am J Hum Biol 2004; 16:237-63. [PMID: 15101051 DOI: 10.1002/ajhb.20015] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The prevalence of diabetes is rising worldwide, including women who grew poorly in early life, presenting intergenerational health problems for their offspring. It is well documented that fetuses exposed to maternal diabetes during pregnancy experience both macrosomia and poor growth outcomes in birth size. Less is known about the in utero growth patterns that precede these risk factor expressions. Fetal growth patterns and the effects of clinical class and glycemic control were investigated in 37 diabetic pregnant women and their fetuses and compared to 29 nondiabetic, nonsmoking maternal/fetal pairs who were participants in a biweekly longitudinal ultrasound study with measurements of the head, limb, and trunk dimensions. White clinical class of the diabetic women was recorded (A2-FR) and glycosylated hemoglobin levels taken at the time of measurement assessed glycemic control (median 6.9%, interquartile range 5.6-9.2%). No significant difference in fetal weight was found by exposure. The exposed sample had greater abdominal circumferences from 21 weeks (P < or = 0.05) and shorter legs, but greater upper arm and thigh circumferences accompanied increasing glycemia in the second trimester. In the third trimester, exposed fetuses had a smaller slope for the occipital frontal diameter (P = 0.00) and were brachycephalic. They experienced a proximal/distal growth gradient in limb proportionality with higher humerus / femur ratios (P = 0.04) and arms relatively long by comparison with legs (P = 0.02). HbA1c levels above 7.5% accompanied shorter femur length for thigh circumference after 30 gestational weeks of age. Significant effects of diabetic clinical class and glycemic control were identified in growth rate timing. These growth patterns suggest that hypoxemic and hyperglycemic signals cross-talk with their target receptors in a developmentally regulated, hierarchical sequence. The increase in fetal fat often documented with diabetic pregnancy may reflect altered growth at the level of cell differentiation and proximate mechanisms controlling body composition. These data suggest that the maternal-fetal interchange circuit, designed to share and capture resources on the fetal side, may not have had a long evolutionary history of overabundance as a selective force, and modern health problems drive postnatal sequelae that become exacerbated by increasing longevity.
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Affiliation(s)
- Michelle Lampl
- Department of Anthropology, Emory University, Atlanta, Georgia 30324, USA.
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