Modified Therapy for Gestational Diabetes Using High-Risk and Low-Risk Fetal Abdominal Circumference Growth to Select Strict Versus Relaxed Maternal Glycemic Targets

Kjos, Siri L.; Schaefer-Graf, Ute M.

doi:10.2337/dc07-s216

Cited by 75 publications

(59 citation statements)

References 28 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may explain the normalization of macrosomia rates observed in studies that applied a fetal growth-based approach of individualized GDM therapy. Insulin therapy was given to women with accelerated fetal growth, as indicated by fetal AC Ͼ75th percentile despite maternal glucose being maintained within the target range (10,18). Our findings are in accordance with those of Kitijama et al and Knopp et al (6,7), who showed that high maternal TG levels predicted macrosomia independently of maternal BMI.…”

Section: Schaefer-graf and Associatessupporting

confidence: 82%

Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes Mellitus

Schaefer-Graf

K²,

Kulbacka³

et al. 2008

Diabetes Care

Self Cite

392

263

View full text Add to dashboard Cite

OBJECTIVE -To determine the contribution of maternal glucose and lipids to intrauterine metabolic environment and fetal growth in pregnancies with gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -In 150 pregnancies, serum triglycerides (TGs), cholesterol, free fatty acids (FFAs), glycerol, insulin, and glucose were determined in maternal serum and cord blood during the 3rd trimester. Maternal glucose values came from oral glucose tolerance testing and glucose profiles. Measurements of fetal abdominal circumference (AC) were performed simultaneously with maternal blood sampling and birth weight, and BMI and neonatal fat mass were obtained following delivery.RESULTS -Maternal TGs and FFAs correlated with fetal AC size (at 28 weeks: triglycerides, P ϭ 0.001; FFAs, P ϭ 0.02), and at delivery they correlated with all neonatal anthropometric measures (FFA: birth weight, P ϭ 0.002; BMI, P ϭ 0.001; fat mass, P ϭ 0.01). After adjustment for confounding variables, maternal FFAs and TGs at delivery remained the only parameters independently related to newborns large for gestational age (LGA) (P ϭ 0.008 and P ϭ 0.04, respectively). Maternal FFA levels were higher in mothers with LGA newborns than in those with appropriate for gestational age (AGA) newborns (362.8 Ϯ 101.7 vs. 252.4 Ϯ 10.1, P ϭ 0.002). Maternal levels of TGs, FFAs, and glycerol at delivery correlated with those in cord blood (P ϭ 0.003, P ϭ 0.004, and P ϭ 0.005, respectively). Fetal triglyceride and cholesterol levels were negatively correlated with newborn birth weight (P ϭ 0.001), BMI (P ϭ 0.004), and fat mass (P ϭ 0.001). TGs were significantly higher in small for gestational age (SGA) newborns compared with AGA or LGA newborns, while insulin-to-glucose ratio and FFAs were the highest in LGA newborns.CONCLUSIONS -In well-controlled GDM pregnancies, maternal lipids are strong predictors for fetal lipids and fetal growth. Infants with abnormal growth seem to be exposed to a distinct intrauterine environment compared with those with appropriate growth.

show abstract

Section: Schaefer-graf and Associatessupporting

confidence: 82%

Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes Mellitus

Schaefer-Graf

K²,

Kulbacka³

et al. 2008

Diabetes Care

Self Cite

392

263

View full text Add to dashboard Cite

show abstract

“…However, inclusion of some novel risk variables did not improve test accuracy in our analysis; therefore, and to optimise the cost-effectiveness of the algorithm, these biochemical variables were not included in our prediction model, which was primarily based on cheap and simple variables that are ubiquitously available in an obstetric setting. Nevertheless, women with negative test results should be re-evaluated if clinical signs of GDM such as macrosomia on ultrasound [35] or glycosuria occur during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

et al. 2012

View full text Add to dashboard Cite

Aims/hypothesis It is currently not clear how to construct a time-and cost-effective screening strategy for gestational diabetes mellitus (GDM). Thus, we elaborated a simple screening algorithm combining (1) fasting plasma glucose (FPG) measurement; and (2) a multivariable risk estimation model focused on individuals with normal FPG levels to decide if a further OGTT is indicated. Methods A total of 1,336 women were prospectively screened for several risk factors for GDM within a multicentre study conducted in Austria. Of 714 women (53.4%) who developed GDM using recent diagnostic guidelines, 461 were sufficiently screened with FPG. A risk prediction score was finally developed using data from the remaining 253 women with GDM and 622 healthy women. The screening algorithm was validated with a further 258 pregnant women.Results A risk estimation model including history of GDM, glycosuria, family history of diabetes, age, preconception dyslipidaemia and ethnic origin, in addition to FPG, was accurate for detecting GDM in participants with normal FPG. Including an FPG pretest, the receiver operating Diabetologia (2012) 55:3173-3181 DOI 10.1007/s00125-012-2726 characteristic AUC of the screening algorithm was 0.90 (95% CI 0.88, 0.91

show abstract

“…Other work has shown that LGA offspring of gestational diabetic mothers have increased rates of obesity compared with those born at a normal weight 35 . This has led to the proposal of ultrasound monitoring of the AC to identify those fetuses at high risk and tailoring a stricter diabetic regime, with relaxed control for those at low risk 7 . Four randomised controlled trials have been performed, with three out of four showing a significant reduction in LGA infants at birth when a modified diabetic treatment regime was used in high risk pregnancies (defined as AC > 70 or 75th percentile) 36 …”

Section: Discussionmentioning

confidence: 99%

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

Nesbitt‐Hawes

Tetstall

Gee

et al. 2014

Australas J Ultrason Med

View full text Add to dashboard Cite

Introduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight. Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate. Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae. Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.

show abstract

Modified Therapy for Gestational Diabetes Using High-Risk and Low-Risk Fetal Abdominal Circumference Growth to Select Strict Versus Relaxed Maternal Glycemic Targets

Cited by 75 publications

References 28 publications

Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes Mellitus

Maternal Lipids as Strong Determinants of Fetal Environment and Growth in Pregnancies With Gestational Diabetes Mellitus

A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

Contact Info

Product

Resources

About