Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus

Abstract

Background: Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term.Methods: Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter–Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively.Results: As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis.Conclusion: Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.

Fetal abdominal overgrowth is already present at 20–24 gestational weeks prior to diagnosis of gestational diabetes mellitus

“…As we previously reported 18 , maternal age and pre-pregnancy BMI were significantly higher in patients with GDM, but weight gain until diagnosis of GDM was not higher as compared with normal glucose tolerance (NGT) subjects.…”

“…According to our previous studies, GDM diagnosed at 24–28 GW has already affected FAO in the older (≥ 35 years) and/or obese (BMI ≥ 25 kg/m 2 ) women but not in the young and non-obese women 17 and FAO persisted until delivery despite treatment of GDM 18 . The prevalence of near-term FAO leading to significantly higher infant birth weight and cesarean section rate were threefold higher in GDM with FAO than without FAO at 24–28 GW 18 .…”

“…In the subgroup analysis, as compared with NGT subjects, all GDM subgroups had a higher prevalence of LGA at birth and macrosomia, but young and non-obese group 1 GDM did not (Table 1 , published in Ref. 15 ) 18 .…”

Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57)

“…In this article titled, “Fetal abdominal obesity detected at 24 to 28 weeks of gestation persists until delivery despite management of gestational diabetes mellitus,” Kim et al [ 7 ] investigated whether management of GDM improves fetal abdominal obesity (FAO) in GDM subjects near term. Fetal abdominal overgrowth ratio and odds ratio for FAO were significantly higher in older and/or obese women with GDM but not in young and nonobese women with GDM compared with normal glucose tolerance (NGT) subjects near term.…”

Fetal Abdominal Obesity Detected at 24 to 28 Weeks of Gestation Persists until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57)

“…Secondly, at the time of diagnosis of GDM, the risk of FAO in young and non-obese GDM was not higher than the risk in women with normal glucose tolerance (NGT), but the risk of FAO was significantly increased in those who were older and/or obese with GDM [ 2 ]. Near term, although the risk of FAO in young and non-obese GDM was not higher than in NGT subjects, the risk of FAO in older and/or obese subjects with GDM was persistently higher than in NGT subject despite treatment [ 3 ]. We suggest that the risk of FAO in young and non-obese GDM remained as low as NGT with appropriate treatment, but that the increased risk for FAO in older and/or obese GDM was not improved.…”