Increased fetal adiposity: A very sensitive marker of abnormal in utero development

Catalano, Patrick M.; Thomas, Alicia; Huston-Presley, Larraine; Amini, Saeid B.

doi:10.1016/s0002-9378(03)00828-7

Cited by 457 publications

(363 citation statements)

References 17 publications

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“…While in early pregnancy hyperglycaemia may lead to restricted fetal growth via reduction in trophoblast proliferation, later in pregnancy, fetal hyperglycaemia and hyperinsulinaemia lead to increased placental angiogenesis, increased and altered vascular endothelial-like growth factor and chorionic villous branching, which, in turn, lead to placental vascular dysfunction [39]. As a result, infants of mothers with diabetes may have an unhealthy body composition (increased body fat) even if they have appropriate birthweight for gestational age [40]. If hyperglycaemia-related growth in the third trimester is mostly associated with the deposition of adipose tissue, this might partly explain our finding of an increased association between third-trimester HbA 1c and birthweight with increasing maternal BMI.…”

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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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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“…Maternal weight gain during gestation is positively correlated with birthweight 27 and neonatal body composition, 28 but evidence relating this condition to overweight or obesity during childhood is lacking. The observations in the present study may be a latter sign of prenatal programming of adipogenesis, and weight gain during pregnancy may be an early 'window' during which variations in nutrition, energy balance 29 or weight gain may programme subsequent growth and development, rendering the offspring more likely to overweight and obesity during childhood.…”

Section: Discussionmentioning

confidence: 99%

Maternal weigh gain during pregnancy and overweight in Portuguese children

et al. 2007

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Objective: The objective of our study was to assess the association between maternal weight gain during pregnancy and childhood overweight. Design: This study was a cross-sectional analysis. Setting: The data were derived from a community-based survey of children from primary schools of Portugal. Subjects: The study was performed in a sample of 6-12-year-old Portuguese school children (2445 girls and 2400 boys; age was 8.570.91 years). Measurements: Height and weight were measured according to international standards, and body mass index (BMI) was calculated. The definition of overweight was based on average centiles according to the International Obesity Task Force cutoffs. Children's parents completed a self-administered questionnaire, which provided information on general family background characteristics, maternal weight gain during pregnancy and children's physical activity. The response rate was 70.6%. Children's dietary intake was measured using a 24-h dietary recall. Logistic regression models were fitted to estimate the magnitude of the association between maternal weight gain during pregnancy and overweight in their children, adjusting for confounders (gender, age, birthweight, order of birth, breastfeeding, smoking during pregnancy, physical activity, parental BMI, parental education, calcium to protein ratio and energy intake). Results: The prevalence of overweight (including obesity) was 29% in boys and 33% in girls. The odds favouring overweight (including obesity) increased significantly for those women who gained X16 kg during pregnancy, compared to those with o9 kg , even after adjustment for confounders (crude odds ratio (OR) ¼ 1.53, confidence interval (CI) 95% 1.27-1.84, P-trend o0.001; Adjusted OR ¼ 1.27, CI 95% 1.01-1.61, P-trend ¼ 0.038). Conclusion: Large maternal weight gain during pregnancy (X16 kg) was significantly associated with higher risk of overweight in Portuguese children.

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“…The premise for GDM treatment is, in part, based on the assumption of a positive independent relationship between maternal glycaemia and neonatal adiposity (Catalano et al, 2003;Stuebe et al, 2012;Aris et al, 2014). The Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study revealed strong, predominantly linear associations between maternal glycaemia and birthweight 490th percentile, per cent body fat (BF%) 490th percentile, pre-eclampsia, caesarean childbirth, shoulder dystocia and clinical neonatal hypoglycaemia (HAPO, 2008(HAPO, , 2009).…”

Section: Introductionmentioning

confidence: 99%

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes

Raynes‐Greenow

Turner

et al. 2016

Midwifery

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a b s t r a c tObjective: Pregnancies complicated with gestational diabetes mellitus (GDM) are at a higher risk for caesarean and instrumental deliveries as well as adverse neonatal outcomes such as fetal overgrowth, hypoglycaemia and neonatal intensive care admission. Our primary objective was to describe neonatal outcomes in a sample that included term infants of both GDM mothers and mothers with normal glucose tolerance (NGT). Design and setting: this cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Maternal and neonatal data were collected from medical records and a questionnaire. Glycaemic control data was based on third trimester HbA1c levels and self-monitoring blood glucose levels (BGL). Univariate associations between GDM status and maternal demographic factors, as well as pregnancy outcomes, were estimated using χ 2 tests and t-tests, as appropriate. Findings: of 599 babies, 67(11%) were born to GDM mothers. GDM mothers were more likely to be overweight/obese and of Asian ethnicity. Good glycaemic control was achieved in most GDM mothers. GDM babies were more likely to have been induced (p ¼0.013) and delivered earlier than non-GDM mothers (p o0.001), and they were also more likely to be breastfed within one hour of birth. Conclusions and implications for practice: in this study, GDM infants were more likely to be induced and delivered earlier but otherwise they did not have significantly different neonatal outcomes compared to infants of NGT mothers. This can be attributed to the good GDM control by lifestyle modification and insulin if necessary. The role of labour induction in GDM pregnancies should be further investigated. Midwives have an important role in maternal education during pregnancy and in the postnatal period.

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Increased fetal adiposity: A very sensitive marker of abnormal in utero development

Cited by 457 publications

References 17 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

Maternal weigh gain during pregnancy and overweight in Portuguese children

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes

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