Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia

McGrath, Rachel T.; Glastras, Sarah J.; Hocking, Samantha

doi:10.2337/dc18-0551

Cited by 50 publications

(43 citation statements)

References 76 publications

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“…However, in previous reviews, despite significant reductions in serious adverse perinatal outcomes for women with T1DM during pregnancy, the opposite effect was observed on fetal overgrowth and associated complications. Pregnant women with T1DM who seemingly achieve adequate glycemic control during pregnancy often exhibit strongly fluctuating glycemic variability and sometimes continue to experience a greater risk of excess fetal growth, leading to heavy-for-dates infants and macrosomia [38]. Thus, several key points in the management of T1DM during pregnancy remain to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

et al. 2020

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Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester � 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels � 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage � 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.

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Section: Discussionmentioning

confidence: 99%

Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

et al. 2020

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“…Excessive fetal growth elevates the risk of acute and longterm complications for mothers and their offspring [1,2]. Although gestational diabetes mellitus (GDM) is an established risk factor [3], mothers who seemingly achieve adequate glycemic control continue to experience a greater risk of fetal overgrowth [4,5]. Thus, GDM may not be the only stimulus that drives fetal overgrowth and other potential contributors remain to be explored.…”

Section: Introductionmentioning

confidence: 99%

Combined Effect of Maternal Vitamin D Deficiency and Gestational Diabetes Mellitus on Trajectories of Ultrasound-Measured Fetal Growth: A Birth Cohort Study in Beijing, China

Liu

et al. 2020

Journal of Diabetes Research

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Objective. Few studies have examined whether maternal 25(OH)D deficiency and gestational diabetes mellitus (GDM) jointly affect fetal growth. We aimed to examine the separate and combined effects of maternal 25(OH)D deficiency and GDM on trajectories of fetal growth. Methods. We established a birth cohort (2016-2017) with 10,913 singleton pregnancies in Tongzhou Maternal and Child Health Hospital of Beijing, China. Maternal 25(OH)D deficiency (serum 25OHD concentration<20.0 ng/mL) was detected, and GDM was diagnosed at 24~28 gestational weeks. Fetal growth was assessed by longitudinal ultrasound measurements of estimated fetal weight (EFW) and abdominal circumference (AC) from 28 gestational weeks to delivery, both of which were standardized as gestational-age-adjusted Z-score. A k-means algorithm was used to cluster the longitudinal measurements (trajectories) of fetal growth. Logistic regression models were used for estimating exposure-outcome associations and additive interactions. Results. We identified two distinct trajectories of fetal growth, and the faster one resembling the 90th centile curve in the reference population was classified as excessive fetal growth. Maternal 25(OH)D deficiency and GDM were independently associated with an increased risk of excessive fetal growth. The combination of maternal 25(OH)D deficiency and GDM was associated with an increased risk of excessive fetal growth assessed by EFW Z-score (odds ratio (OR): 1.36; 95% confidence interval (CI): 1.15~1.62) and AC Z-score (OR (95% CI): 1.32 (1.11~1.56)), but the relative excess risks attributable to interaction were nonsignificant (P>0.05). Conclusion. Maternal 25(OH)D deficiency and GDM may jointly increase the risk of excessive fetal growth. Interventions for pregnancies with GDM may be more beneficial for those with 25(OH)D deficiency than those without regarding risk of excessive fetal growth, if confirmed in a large sample.

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“…19 A recent review highlighted the importance of diabetes and foetal macrosomia, focussing on the link between the two even where appropriate glycaemic control was achieved. 18 The interaction model in the current study found interesting reductions in the odds for obese and overweight women with diabetes, especially the protective effect of obesity and preexisting diabetes. It is possible that this effect arises from care-giving practices during the pregnancy, with well-established care protocols available for diabetes in pregnancy.…”

Section: Discussionmentioning

confidence: 51%

“…Low birthweight has been linked with underweight mothers 15 , younger or older maternal age 15,16 , ethnicity or immigrant status [15][16][17] , low socio-economic status 15 , reduced educational attainment 16 , being unmarried 16 , primiparity 16 , low or high blood pressure 15 , and pregnancy complications. 16 High birthweights have been associated with increased maternal weight or BMI 18,19 , higher parity 17 , and type 1 diabetes. 18 While much is known about birthweight, changing patterns of maternal demographics in developed countries, such as increasing maternal age, increasing BMI, and a reduction in smoking rates requires regular review of the characteristics associated with sub-optimal birthweight in neonates.…”

Section: Factors Associated With Birthweight Outcomesmentioning

confidence: 99%

“…16 High birthweights have been associated with increased maternal weight or BMI 18,19 , higher parity 17 , and type 1 diabetes. 18 While much is known about birthweight, changing patterns of maternal demographics in developed countries, such as increasing maternal age, increasing BMI, and a reduction in smoking rates requires regular review of the characteristics associated with sub-optimal birthweight in neonates.…”

Section: Factors Associated With Birthweight Outcomesmentioning

confidence: 99%

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Novel green space measures and birthweight in Queensland, Australia

Vilcins¹

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IntroductionEnvironmental exposures can contribute both benefits and risks to human health. Green space represents an environmental exposure that may confer benefits to human health. There are several proposed benefits to green space exposure, such as improving mental wellbeing, increasing physical activity, improving the social cohesion of local neighbourhoods, reducing the negative effect of environmental risk factors, and improving exposure to beneficial microbiota. One of the proposed health benefits is an improvement in the health outcomes of neonates. Maternal exposure to green space has been associated with improvements in birthweight, among other birth outcomes. The developmental origins of health and disease hypothesis suggests that investing in healthy foetal development in Utero confers benefits across the life span. This makes an assessment of the potential impacts of environmental exposures on foetal development an important undertaking in population health. The current body of evidence on birthweight and maternal green space exposure is limited to a handful of exposure measures and coarse allocation of exposure. Newer measures of green space have been developed, which allows for an exploration of the effect of different ground covers (green, dry and bare earth), as well as measures of biodiversity, on health. This thesis explores the association of these novel green space measures with birthweight in a large birth cohort in Queensland, Australia. ObjectivesThis study has several objectives: 1) to examine the maternal and socio-demographic characteristics associated with birthweight; 2) to test for an association between green space, dry cover and bare earth and birthweight outcomes, controlling for the maternal and social factors; 3) to test whether foliage projective cover, a measure of crown canopy shading, is associated with birthweight outcomes; 4) to explore whether effects of green space differ between rural and urban communities; 5) to explore the interaction of green space with other environmental variables, namely air pollution and ambient temperature; and 6) to explore whether biodiversity is associated with birthweight outcomes. MethodsSeveral data sets were acquired and merged to create the data set used in this study. The outcome was birthweight (in grams and age-standardised), and this was acquired along with maternal covariates from the routine health records available for all births in Queensland, Australia. Social and neighbourhood variables were acquired from the Australian Bureau of Statistics. The exposures of interest to this study were green space (fractional cover, biodiversity and foliage projective iii cover), ambient temperature and air pollution. Directed acyclic graphs were developed to guide variable selection in all analyses. Mixed-effects linear regression and generalised linear mixedeffects models were developed, with random intercepts for maternal residential locality and year of birth. Results are presented as standardised beta coefficients or odds ratios, with 95% ...

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Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia

Cited by 50 publications

References 76 publications

Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy

Combined Effect of Maternal Vitamin D Deficiency and Gestational Diabetes Mellitus on Trajectories of Ultrasound-Measured Fetal Growth: A Birth Cohort Study in Beijing, China

Novel green space measures and birthweight in Queensland, Australia

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