Fetal and Neonatal Outcomes of Diabetic Pregnancies

Yang, Joanne; Cummings, Elizabeth A.; O’Connell, Colleen; Jangaard, Krista

doi:10.1097/01.aog.0000231688.08263.47

Cited by 320 publications

(228 citation statements)

References 23 publications

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“…Maternal diabetes is also associated with a higher risk of aberrant fetal growth. About 50% of infants born to mothers with pre-conception diabetes are reported to be macrosomic or large for gestational age (LGA), although there is overlap in the definition of both of these terms (usually defined as birthweight >90th centile for gestational age) [5][6][7][8]. Small for gestational age (SGA) is less often associated with maternal diabetes per se, but has been reported in association with severe vascular complications [9,10] and can result in higher neonatal morbidity and mortality.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…During pregnancy, diabetes causes reproductive abnormalities that enhance spontaneous abortion, congenital anomalies, and neonatal morbidity and mortality (1,2). Excessive oxidative stress has been implicated in the pathology and complications of diabetic pregnancy (3).…”

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confidence: 99%

Effect of Ginkgo biloba on the reproductive outcome and oxidative stress biomarkers of streptozotocin-induced diabetic rats

Rudge

Damasceno

Volpato

et al. 2007

Braz J Med Biol Res

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The aim of the present study was to evaluate the effect of Ginkgo biloba treatment (EGb 761, 200 mg kg -1 day -1 ) administered from day 0 to 20 of pregnancy on maternal reproductive performance and on the maternal and fetal liver antioxidant systems of streptozotocin-induced diabetic Wistar rats. On day 21 of pregnancy, the adult rats (weighing approximately 250 ± 50 g, minimum number = 13/group) were anesthetized to obtain maternal and fetal liver samples for superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total glutathione (GSH-t) determinations. The uterus was weighed with its contents. The diabetic (G3) and treated diabetic (G4) groups of rats presented significant maternal hyperglycemia, reduced term pregnancy rate, impaired maternal reproductive outcome and fetal-placental development, decreased GSH-Px (G3 = G4 = 0.6 ± 0.2) and SOD (G3 = 223.0 ± 84.7; G4 = 146.1 ± 40.8), and decreased fetal CAT activity (G3 = 22.4 ± 10.6; G4 = 34.4 ± 14.1) and GSH-t (G3 = G4 = 0.3 ± 0.2), compared to the non-diabetic groups (G1, untreated control; G2, treated). For G1, maternal GSH-Px = 0.9 ± 0.2 and SOD = 274.1 ± 80.3; fetal CAT = 92.6 ± 82.7 and GSH-t = 0.6 ± 0.5. For G2, G. biloba treatment caused no toxicity and did not modify maternal or fetal-placental data. EGb 761 at the nontoxic dose used (200 mg kg -1 day -1 ), failed to modify the diabetes-associated increase in maternal glycemia, decrease in pregnancy rate, decrease in antioxidant enzymes, and impaired fetal development when the rats were treated throughout pregnancy (21 days).

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“…Observou-se um aumento global na prevalência de diabetes preexistente à gravidez 1,13,14 . Esse aumento, para além de baseado no aumento da prevalência da doença em idades mais jovens 15,16 , reflete o aumento dos casos de DM tipo 2 demonstrado em estudos de base populacional, principalmente em países desenvolvidos 8,13 . Em nosso estudo, os resultados foram divergentes dessa realidade: globalmente, nenhuma tendência foi encontrada em relação ao número de gestantes com DM seguidas no nosso centro.…”

Section: Discussionunclassified

“…Estudos recentes, de base populacional, revelaram que nas últimas duas décadas, apesar do esforço de melhoras nos cuidados da população de gestantes diabéticas, estas continuaram apresentando os piores resultados obstétricos e perinatais, quando comparadas com gestantes não diabéti-cas, e que as taxas de mortalidade perinatal, malformações fetais e macrossomia não sofreram melhoras significativas 7,8 .…”

Section: Introductionunclassified

Prognóstico obstétrico de pacientes portadoras de diabetes mellitus pré-gestacional

Fernandes¹,

Simões²,

Figueiredo³

et al. 2012

Rev. Bras. Ginecol. Obstet.

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Sílvia maRgaRida duaRte teixeiRa gueRRa aRagüéS 3 njila Yakalage baRReiRa amaRal 3 Resumo OBJETIVO: Avaliar as alterações epidemiológicas, de perfil clínico e de prognóstico obstétrico em pacientes portadoras de diabetes mellitus pré-gestacional. MÉTODOS: Estudo retrospetivo (coorte) de todas as gestações simples, com diagnóstico de diabetes prévio que foram seguidas num centro com apoio perinatal diferenciado entre 2004 e 2011 (n=194). Analisaram-se tendências relacionadas com dados demográficos e variáveis clínicas maternas, dados de indicadores de cuidados pre-concepcionais e durante a gravidez, e de controle metabólico. Dados do parto como a idade gestacional (IG) do parto, via do parto e peso do neonato foram variáveis também estudadas. RESULTADOS: A frequência global de diabetes prévia, durante o período estudado, foi de 4,4 por mil, não se verificando variações significativas durante o período de estudo. Os casos de diabetes tipo 2 permaneceram constantes. Em 67% dos casos o parto foi de termo (máximo de 80% em 2010-2011), registrou-se uma redução significativa dos partos por cesárea eletiva (p=0,03) e na incidência de neonatos considerados grandes para a IG (p=0,04) ao longo dos anos em estudo. Apesar dos bons resultados relacionados com o controle metabólico ao longo da vigilância da gravidez não foi registrada nenhuma melhora ao longo do tempo. Da mesma forma a proporção de gestantes diabéticas com avaliação pre-concepcional permaneceu pouco animadora. CONCLUSÕES: O seguimento de gestantes portadoras de diabetes mellitus em unidades multidisciplinares parece permitir um ajuste metabólico tão precoce quanto possível, de forma a conseguir melhorar o prognóstico obstétrico. A melhora nos cuidados pré-concepcionais continua sendo um desafio. Abstract PURPOSE:To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes. METHODS: Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight. RESULTS: The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010-11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement. CONCLUSIONS: ...

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Fetal and Neonatal Outcomes of Diabetic Pregnancies

Cited by 320 publications

References 23 publications

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

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

Effect of Ginkgo biloba on the reproductive outcome and oxidative stress biomarkers of streptozotocin-induced diabetic rats

Prognóstico obstétrico de pacientes portadoras de diabetes mellitus pré-gestacional

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