Sonographic Evaluation of Fetal Growth and Body Composition in Women With Different Degrees of Normal Glucose Metabolism

Abstract

OBJECTIVE -To investigate the maternal demographic and metabolic factors contributing to the growth of fetal lean and fat body mass in women whose degree of glucose intolerance is less than that defining gestational diabetes in comparison with women with normal glucose metabolism.RESEARCH DESIGN AND METHODS -Longitudinal sonographic examinations of 66 singleton fetuses without anomalies of nonobese mothers with abnormal oral glucose challenge test (GCT) results and without gestational diabetes (group 1) were compared with those of 123 singleton fetuses without anomalies of nonobese mothers with normal GCT values (group 2). Lean body mass measurements included head circumference, femur length, mid-upper arm, and mid-thigh central areas. Fat body mass measurements included the anterior abdominal wall thickness, the subscapular thickness, and the mid-upper arm and mid-thigh subcutaneous areas. All the women performed a 24-h glucose profile on the day preceding the ultrasound scan. Multivariate logistic regression analysis established best-fit equations for fetal sonographic measurements of fat and lean body mass. Independent variables included groups 1 and 2, maternal age, parity, prepregnancy BMI, gestational age, weight gain during pregnancy, fetal sex, and the following averaged 24-h profile maternal capillary blood glucose values: preprandial, 1-h postprandial, and 2-h postprandial. RESULTS -No difference was found between the two groups with respect to fetal lean body mass parameters; the factors that contributed significantly and most frequently were gestational age and fetal sex (male). With respect to fetal fat body mass, all the measurements were significantly higher in group 1 than in group 2. In all instances, the significantly contributing factors were gestational age and maternal 1-h postprandial glucose values, whereas another frequent contributor was prepregnancy BMI.CONCLUSIONS -Our study suggests the possibility of using sonographically determined fetal fat and lean mass measurements as indicators of body composition. The assessment of these parameters, achievable in a noninvasive and reproducible fashion in pregnancies complicated by glucose intolerance, might enable the real-time detection of fetal overgrowth and disproportion, thus opening the possibility of exploring interventions to limit fetal fat accretion, birth weight, and potential resulting morbidity. Diabetes Care 26:2741-2748, 2003G estational alterations in maternal metabolism provide nutrients in excess of those required for normal fetal growth and for maternal and fetal energy requirements. In this context, the presence of any degree of abnormal glucose tolerance, even if less than that conventionally required for the diagnosis of gestational diabetes, represents an altered environment for the growth of the fetus (1-7).The excess supply of nutrients caused by altered glucose tolerance is most easily discerned through fetal fat body mass, which has been shown to be more closely associated with maternal glucose control than birth weig...

A foetal energy balance equation based on maternal exercise and diet

“…Conversely, when glucose availability increases, the rate of release decreases which upregulates IGFs and downregulates IGFbinding proteins in the foetal compartment resulting in an increased foetal growth rate. As a result, we assume that the rate of kcal ingested by the foetus is an increasing function of placental volume, total maternal kcal ingested and the glycaemic index of the maternal diet ( Fraser et al 1988;Clapp 1998Clapp , 2002Parretti et al 2003;Scholl et al 2004;Moses et al 2006). (iv) The pregnancy is considered normal and the foetus is not deprived of energy required to grow.…”

Ultrasound Surveillance in Pregnancy Complicated by Diabetes

“…22 Many studies have used these findings and applied them to measurements obtained during fetal sonography. [23][24][25][26] Results of these studies indicate that fetal fat, and in particular the truncal fat layer, has a stronger correlation with maternal glycemic control than does estimation of birth weight.…”

Distribution of the glycoconjugate oligosaccharides in the human placenta from pregnancies complicated by altered glycemia: lectin histochemistry

“…Some investigations have demonstrated that also the MDGI is a signiWcant risk factor for fetal growth and its attendant problems (Kaufmann et al 1992;Berkus and Langer 1993;Moses and Calvert 1995;Thomas et al 2002;Parretti et al 2003).…”