Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Schaefer-Graf, Ute M.; Kjos, Siri L.; Kilavuz, Ö.; Plagemann, Andreas; Bräuer, Martin; Dudenhausen, Joachim W.; Vetter, K.

doi:10.2337/diacare.26.1.193

Cited by 103 publications

(75 citation statements)

References 24 publications

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“…33,34 However, in our study maternal GDM status did not predict LGA infants nor high %BF. 35 This may be attributed to the tight glycaemic control previously reported in our maternal population mitigating the effects of maternal hyperglycaemia on the fetus.…”

Section: Main Findingscontrasting

confidence: 83%

Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes

et al. 2014

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OBJECTIVE:To compare body composition of large-for-gestational-age (LGA) with appropriate-for-gestational-age (AGA) newborns and to identify antenatal predictors of LGA. STUDY DESIGN: This cross-sectional study included 536 term, singleton infants. Anthropometric measurements were performed within 48 h of birth and included determination of body fat percentage (%BF) by air displacement plethysmography. Associations were investigated using logistic regression. RESULT:LGA infants had greater %BF (P o 0.001) compared with AGA infants. Significant predictors of LGA infants included parity (odds ratio (OR) = 1.98, (95% confidence interval (CI) 1.00, 4.02)), paternal height (OR = 1.08, (95% CI 1.03, 1.14)), maternal pregravid weight (65 to 74.9 kg: OR = 2.77, (95% CI 1.14, 7.06)) and gestational weight gain (OR = 1.09, 95% CI (1.03, 1.16)). Gestational diabetes mellitus was not associated with LGA infants (P = 0.598). CONCLUSION: Paternal height, parity, maternal pregravid weight and gestational weight gain were strongly associated with LGA infants. These results may allow early prediction and potential modification, thereby optimising clinical outcomes.

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Section: Main Findingscontrasting

confidence: 83%

Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes

et al. 2014

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“…30) and a previous history of macrosomia were the only early predictors of large-for-gestational age infants among women with impaired glucose tolerance in pregnancy (30). From gestational week 28 fasting glucose level was also an independent predictor.…”

Section: Discussionmentioning

confidence: 88%

Maternal anthropometric and metabolic factors in the first half of pregnancy and risk of neonatal macrosomia in term pregnancies. A prospective study

Clausen¹,

Burski²,

et al. 2005

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Objective: The prevalence of maternal overweight and fetal macrosomia is increasing. Fetal macrosomia is associated with increased risk of maternal and neonatal complications. The objective of the present study was to investigate if maternal metabolic parameters associated with maternal overweight were independent determinants of macrosomia (birth weight .4500 g or above the 95 percentile of the z-score for standardized birth weight). Design: Prospective population based cohort study of 2050 pregnancies and nested case control study. Methods: Outcome measures were adjusted risks for macrosomia in relation to early second trimester maternal serum lipids, glucose and insulin (cohort study) and leptin and insulin-like growth factor (73 cases and 146 matched controls). Results: Gestational diabetes was not independently associated with fetal macrosomia. First trimester body mass index (BMI), gestational weight gain and placental weight were associated with macrosomia. High serum insulin and non-high density lipoprotein (HDL)-cholesterol and low serum HDL-cholesterol were associated with increased risk of macrosomia independent of BMI, weight gain, placental weight and gestational diabetes. Slim women with macrosomic infants had higher insulin compared with those with normal weight infants. This relation was not found among obese women. Leptin was not associated with macrosomia after adjusting for maternal BMI. Conclusions: Blood parameters known to be associated with the metabolic syndrome were risk factors for macrosomia independent of maternal BMI.European Journal of Endocrinology 153 887-894

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“…Although earlier studies have not LGA was defined as birthweight ≥90th centile, and SGA as birthweight <10th centile, according to Scottish birthweight standards (by fetal sex, parity and gestational age) [24] HbA 1c was reported to be a significant predictor of LGA birthweight in a cohort of women with type 1, type 2 and gestational diabetes after adjustment for a number of confounders [30]. In a study of pregnancies complicated by gestational diabetes or impaired glucose tolerance, maternal fasting glycaemia during 32-35 weeks was the strongest predictor of accelerated growth in the late third trimester, whereas in the late second and early third trimester and at birth the dominant predictors were previous LGA or maternal obesity [29]. The Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study reported that mild antenatal maternal hyperglycaemia in women without known diabetes is also associated with an increased risk of LGA [28].…”

Section: Discussionmentioning

confidence: 99%

HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study

et al. 2012

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Aims/hypothesis To investigate clinical and sociodemographic predictors of birthweight in singletons born to women with type 1 or type 2 diabetes. Methods Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n01,505). Associations between potential predictors and birthweight were analysed by multiple regression. Results Potentially modifiable independent predictors of increase in birthweight were pre-pregnancy care (adjusted regression coefficient [b]087.1 g; 95% CI 12.9, 161.3), increasing third-trimester HbA 1c ≤7% (53 mmol/mol) (b0310.5 g per 1% [11 mmol/mol]; 95% CI 246.3, 374.7) and increasing maternal BMI (b09.5 g per 1 kg/m 2 ; 95% CI 3.5, 15.5). Smoking during pregnancy (b0−145.1 g; 95% CI −231.4, −58.8), later gestation at first antenatal visit (b0−15.0 g; 95% CI −26.9, −3.0) and higher peri-conception HbA 1c (b0−48.2 g; 95% CI −68.8, −27.6) were independently associated with birthweight reduction. Pre-pregnancy nephropathy (b 0−282.7 g; 95% CI −461.8, −103.6) and retinopathy (b0−175.5 g; 95% CI −269.9, −81.0) were independent non-modifiable predictors of reduced birthweight, while greater maternal height was a non-modifiable predictor of increasing birthweight (b017.8 g; 95% CI 12.3, 23.2). Other predictors of birthweight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birthweight. Conclusions/interpretation Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA 1c predicting weight reduction and increasing third-trimester HbA 1c predicting increased birthweight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.

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Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Cited by 103 publications

References 24 publications

Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes

Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes

Maternal anthropometric and metabolic factors in the first half of pregnancy and risk of neonatal macrosomia in term pregnancies. A prospective study

HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study

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