1
|
Borboa-Olivares H, Torres-Torres J, Flores-Pliego A, Espejel-Nuñez A, Camacho-Arroyo I, Guzman-Huerta M, Perichart-Perera O, Piña-Ramirez O, Estrada-Gutierrez G. AI-Enhanced Analysis Reveals Impact of Maternal Diabetes on Subcutaneous Fat Mass in Fetuses without Growth Alterations. J Clin Med 2023; 12:6485. [PMID: 37892622 PMCID: PMC10607577 DOI: 10.3390/jcm12206485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Pregnant women with diabetes often present impaired fetal growth, which is less common if maternal diabetes is well-controlled. However, developing strategies to estimate fetal body composition beyond fetal growth that could better predict metabolic complications later in life is essential. This study aimed to evaluate subcutaneous fat tissue (femur and humerus) in fetuses with normal growth among pregnant women with well-controlled diabetes using a reproducible 3D-ultrasound tool and offline TUI (Tomographic Ultrasound Imaging) analysis. Additionally, three artificial intelligence classifier models were trained and validated to assess the clinical utility of the fetal subcutaneous fat measurement. A significantly larger subcutaneous fat area was found in three-femur and two-humerus selected segments of fetuses from women with diabetes compared to the healthy pregnant control group. The full classifier model that includes subcutaneous fat measure, gestational age, fetal weight, fetal abdominal circumference, maternal body mass index, and fetal weight percentile as variables, showed the best performance, with a detection rate of 70%, considering a false positive rate of 10%, and a positive predictive value of 82%. These findings provide valuable insights into the impact of maternal diabetes on fetal subcutaneous fat tissue as a variable independent of fetal growth.
Collapse
Affiliation(s)
- Hector Borboa-Olivares
- Community Interventions Research Branch, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | - Johnatan Torres-Torres
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Arturo Flores-Pliego
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City 11000, Mexico; (A.F.-P.); (A.E.-N.)
| | - Aurora Espejel-Nuñez
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City 11000, Mexico; (A.F.-P.); (A.E.-N.)
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatologia-Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 11000, Mexico;
| | - Mario Guzman-Huerta
- Department of Translational Medicine, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Otilia Perichart-Perera
- Nutrition and Bioprogramming Department, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Omar Piña-Ramirez
- Bioinformatics and Statistical Analysis Department, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | | |
Collapse
|
2
|
Zhang Y, Chen L, Zhang L, Wu Y, Li L. Fasting plasma glucose and fetal ultrasound predict the occurrence of neonatal macrosomia in gestational diabetes mellitus. BMC Pregnancy Childbirth 2023; 23:269. [PMID: 37076807 PMCID: PMC10114470 DOI: 10.1186/s12884-023-05594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE The cause of fetal overgrowth during pregnancy is still unclear. This study aimed to analyze and predict the risk of macrosomia in pregnant women with gestational diabetes mellitus (GDM). METHODS This study was a retrospective study collected from October 2020 to October 2021. A total of 6072 pregnant women with a routine 75-g oral glucose tolerance test (OGTT) during 24-28 gestational weeks were screened. Nearly equal numbers of pregnant women with gestational diabetes and with normal glucose tolerance (NGT) were included in the study. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were performed to determine the index and inflection point for predicting macrosomia occurrence. RESULTS The data of perinatal outcomes of 322 GDM and 353 NGT who had given birth to single live babies at term were analyzed. We found that significant cut-off values for the prediction of macrosomia are 5.13mmol/L in fasting plasma glucose (FPG), 12.25kg in gestational weight gain (GWG), 3,605g in ultrasound fetal weight gain (FWG) and 124mm in amniotic fluid index (AFI).The area under the ROC curve of this predictive model combined all variables reached 0.953 (95% CI: 0.914 ~ 0.993) with a sensitivity of 95.0% and a specificity of 85.4%. CONCLUSIONS FPG is positively associated with newborn birth weight. An early intervention to prevent macrosomia may be possible by combining maternal GWG, FPG, FWG, and AFI in gestational diabetes.
Collapse
Affiliation(s)
- Yuting Zhang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Linying Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Lijing Zhang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yudan Wu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Li Li
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
| |
Collapse
|
3
|
Scarpato R, Colosimo V, Chiaramonte A, Di Bello D, Esposti V, Falaschi A, Ghirri P, Micheli C, Testi S. High level of γH2AX phosphorylation in the cord-blood cells of large-for-gestational-age (LGA) newborns. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 881:503526. [PMID: 36031337 DOI: 10.1016/j.mrgentox.2022.503526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Newborns can experience adverse effects as a consequence of maternal or in utero exposure, altered growth of the fetus, or placental dysfunctions. Accurate characterization of gestational age allows monitoring of fetal growth, identification of deviations from the normal growth trajectory, and classification of babies as adapted, small, or large for gestational age (AGA, SGA, or LGA). The aim of this work was to evaluate nuclear and oxidative damage in umbilical cord-blood cells of newborns (sampled at birth), by applying the γH2AX assay and the fluorescent probe BODIPY581/591 C11, to detect DNA DSB and cell membrane oxidation, respectively. No statistically significant differences were observed in the proportion of oxidized cord-blood cells among the groups of newborns, although the LGA group showed the highest value. With regard to genome damage, elevated levels of γH2AX foci were detected in the cell nuclei from LGA newborns as compared to AGA or SGA babies, whose values did not differ from each other. Considering that the observed DNA damage, although still repairable, can represent a risk factor for obesity, metabolic diseases, or other pathologies, monitoring genome and cell integrity at birth can provide useful information for prevention of diseases later in life.
Collapse
Affiliation(s)
- Roberto Scarpato
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy.
| | - Valentina Colosimo
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Anna Chiaramonte
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Women-Child-Newborn Obstetrics and Gynaecology, Milano, Italy
| | - Domenica Di Bello
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Veronica Esposti
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Aurora Falaschi
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Paolo Ghirri
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Consuelo Micheli
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| | - Serena Testi
- Unità di Genetica, Dipartimento di Biologia, University of Pisa, Pisa, Italy
| |
Collapse
|
4
|
Jing G, Huwei S, Chao C, Lei C, Ping W, Zhongzhou X, Sen Y, Jiayuan C, Ruiyao C, Lu L, Shuqing L, Kaixiang Y, Jie X, Weiwei C. A predictive model of macrosomic birth based upon real-world clinical data from pregnant women. BMC Pregnancy Childbirth 2022; 22:651. [PMID: 35982421 PMCID: PMC9386989 DOI: 10.1186/s12884-022-04981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal macrosomia is associated with an increased risk of several maternal and newborn complications. Antenatal predication of fetal macrosomia remains challenging. We aimed to develop a nomogram model for the prediction of macrosomia using real-world clinical data to improve the sensitivity and specificity of macrosomia prediction. METHODS In the present study, we performed a retrospective, observational study based on 13,403 medical records of pregnant women who delivered singleton infants at a tertiary hospital in Shanghai from 1 January 2018 through 31 December 2019. We split the original dataset into a training set (n = 9382) and a validation set (n = 4021) at a 7:3 ratio to generate and validate our model. The candidate variables, including maternal characteristics, laboratory tests, and sonographic parameters were compared between the two groups. A univariate and multivariate logistic regression was carried out to explore the independent risk factors for macrosomia in pregnant women. Thus, the regression model was adopted to establish a nomogram to predict the risk of macrosomia. Nomogram performance was determined by discrimination and calibration metrics. All the statistical analysis was analyzed using R software. RESULTS We compared the differences between the macrosomic and non-macrosomic groups within the training set and found 16 independent risk factors for macrosomia (P < 0.05), including biparietal diameter (BPD), head circumference (HC), femur length (FL), amniotic fluid index (AFI) at the last prenatal examination, pre-pregnancy body mass index (BMI), and triglycerides (TG). Values for the areas under the curve (AUC) for the nomogram model were 0.917 (95% CI, 0.908-0.927) and 0.910 (95% CI, 0.894-0.927) in the training set and validation set, respectively. The internal and external validation of the nomogram demonstrated favorable calibration as well as discriminatory capability of the model. CONCLUSIONS Our model has precise discrimination and calibration capabilities, which can help clinical healthcare staff accurately predict macrosomia in pregnant women.
Collapse
Affiliation(s)
- Gao Jing
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200040, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China
| | - Shi Huwei
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Chen Chao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Road, Shanghai, 200030, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200040, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China
| | - Chen Lei
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Wang Ping
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Xiao Zhongzhou
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Yang Sen
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Chen Jiayuan
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Chen Ruiyao
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Lu Lu
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Luo Shuqing
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China
| | - Yang Kaixiang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, Jiangsu, China
| | - Xu Jie
- Shanghai Artificial Intelligence Laboratory, Shanghai, 200030, China.
| | - Cheng Weiwei
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910 Hengshan Road, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200040, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, 200030, China.
| |
Collapse
|
5
|
Tsantekidou I, Evangelinakis N, Bargiota A, Vrachnis N, Kalantaridou S, Valsamakis G. Macrosomia and fetal growth restriction: evidence for similar extrauterine metabolic risks but with differences in pathophysiology. J Matern Fetal Neonatal Med 2021; 35:8450-8455. [PMID: 34555989 DOI: 10.1080/14767058.2021.1980531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate and compare the causes of macrosomia and FGR fetuses, their ultrasound characteristics and the importance of their similar metabolic profile in intrauterine and extrauterine life. MATERIALS AND METHODS We searched Pubmed/Google Scholar database up until 15 December 2020 using keywords. Out of the 70 matching results we selected 50 most representative and matching papers. RESULTS We found similar causes and metabolic profiles and in both conditions offspring are at increased risk of developing metabolic and cardiovascular diseases in the extrauterine life. CONCLUSION Despite similarities of the maternal factors and fetal metabolic profile it is still unknown which of them has worse metabolic status during intrauterine and extrauterine life.
Collapse
Affiliation(s)
- Inga Tsantekidou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Evangelinakis
- Reproductive Endocrinology Unit, 3rd Department of Obstetrics and Gynecology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Disorders, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Larissa, Greece
| | - Nikolaos Vrachnis
- Reproductive Endocrinology Unit, 3rd Department of Obstetrics and Gynecology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Sophia Kalantaridou
- Reproductive Endocrinology Unit, 3rd Department of Obstetrics and Gynecology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| | - Georgios Valsamakis
- Department of Endocrinology and Metabolic Disorders, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Larissa, Greece.,2nd Department of Obstetrics and Gynecology, University Hospital "Aretaieion", Medical School, National and Kapodistrian University of Athens Greece, Athens, Greece
| |
Collapse
|
6
|
Olmos-Ortiz A, Flores-Espinosa P, Díaz L, Velázquez P, Ramírez-Isarraraz C, Zaga-Clavellina V. Immunoendocrine Dysregulation during Gestational Diabetes Mellitus: The Central Role of the Placenta. Int J Mol Sci 2021; 22:8087. [PMID: 34360849 PMCID: PMC8348825 DOI: 10.3390/ijms22158087] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a transitory metabolic condition caused by dysregulation triggered by intolerance to carbohydrates, dysfunction of beta-pancreatic and endothelial cells, and insulin resistance during pregnancy. However, this disease includes not only changes related to metabolic distress but also placental immunoendocrine adaptations, resulting in harmful effects to the mother and fetus. In this review, we focus on the placenta as an immuno-endocrine organ that can recognize and respond to the hyperglycemic environment. It synthesizes diverse chemicals that play a role in inflammation, innate defense, endocrine response, oxidative stress, and angiogenesis, all associated with different perinatal outcomes.
Collapse
Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico; (A.O.-O.); (P.F.-E.)
| | - Pilar Flores-Espinosa
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico; (A.O.-O.); (P.F.-E.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico;
| | - Pilar Velázquez
- Departamento de Ginecología y Obstetricia, Hospital Ángeles México, Ciudad de México 11800, Mexico;
| | - Carlos Ramírez-Isarraraz
- Clínica de Urología Ginecológica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico;
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPer), Ciudad de México 11000, Mexico
| |
Collapse
|
7
|
Stanirowski PJ, Majewska A, Lipa M, Bomba-Opoń D, Wielgoś M. Ultrasound evaluation of the fetal fat tissue, heart, liver and umbilical cord measurements in pregnancies complicated by gestational and type 1 diabetes mellitus: potential application in the fetal birth-weight estimation and prediction of the fetal macrosomia. Diabetol Metab Syndr 2021; 13:22. [PMID: 33602333 PMCID: PMC7893855 DOI: 10.1186/s13098-021-00634-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the ultrasound-derived measurements of the fetal soft-tissue, heart, liver and umbilical cord in pregnancies complicated by gestational (GDM) and type 1 diabetes mellitus (T1DM), and further to assess their applicability in the estimation of the fetal birth-weight and prediction of fetal macrosomia. METHODS Measurements were obtained from diet-controlled GDM (GDMG1) (n = 40), insulin-controlled GDM (GDMG2) (n = 40), T1DM (n = 24) and healthy control (n = 40) patients. The following parameters were selected for analysis: fetal sub-scapular fat mass (SSFM), abdominal fat mass (AFM), mid-thigh fat/lean mass (MTFM/MTLM) and inter-ventricular septum (IVS) thicknesses, heart and thorax circumference and area (HeC/HeA; ThC/ThA), liver length (LL), umbilical cord/vein/arteries circumference and area (UmC/UmA; UvC/UvA; UaC/UaA) together with total umbilical vessels (UveA) and Wharton's jelly area (WjA). Regression models were created in order to assess the contribution of selected parameters to fetal birth-weight (FBW) and risk of fetal macrosomia. RESULTS Measurements of the fetal SSFM, AFM, MTFM, MTFM/MTLM ratio, HeC, HeA, IVS, LL, UmC, UmA, UaC, UaA, UveA and WjA were significantly increased among patients with GDMG2/T1DM as compared to GDMG1 and/or control groups (p < .05). The regression analysis revealed that maternal height as well as fetal biparietal diameter, abdominal circumference (AC), AFM and LL measurements were independent predictors of the FBW (p < .05). In addition, increase in the fetal AFM, AC and femur length (FL) was associated with a significant risk of fetal macrosomia occurrence (p < .05). The equation developed for the FBW estimation [FBW(g) = - 2254,942 + 17,204 * FL (mm) + 105,531 * AC (cm) + 131,347 * AFM (mm)] provided significantly lower mean absolute percent error than standard formula in the sub-group of women with T1DM (5.7% vs 9.4%, p < .05). Moreover, new equation including AC, FL and AFM parameters yielded sensitivity of 93.8%, specificity 77.7%, positive predictive value 54.5% and negative predictive value of 97.8% in the prediction of fetal macrosomia. CONCLUSIONS Ultrasound measurements of the fetal soft tissue, heart, liver and umbilical cord are significantly increased among women with GDM treated with insulin and T1DM. In addition to standard biometric measurements, parameters, such as AFM, may find application in the management of diabetes-complicated pregnancies.
Collapse
Affiliation(s)
- Paweł Jan Stanirowski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015, Warsaw, Poland.
- Club 35. Polish Society of Gynecologists and Obstetricians, Warsaw, Poland.
| | - Agata Majewska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015, Warsaw, Poland
| | - Michał Lipa
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015, Warsaw, Poland
- Club 35. Polish Society of Gynecologists and Obstetricians, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015, Warsaw, Poland
| | - Mirosław Wielgoś
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Sq. 1/3, 02-015, Warsaw, Poland
| |
Collapse
|
8
|
Bicocca MJ, Le TN, Zhang CC, Blackburn B, Blackwell SC, Sibai BM, Chauhan SP. Identification of newborns with birthweight ≥ 4,500g: Ultrasound within one- vs. two weeks of delivery. Eur J Obstet Gynecol Reprod Biol 2020; 249:47-53. [PMID: 32353616 DOI: 10.1016/j.ejogrb.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to compare the diagnostic characteristics of sonographic estimated fetal weight (SEFW) done within 7 versus 8-14 days before delivery for detection of fetal macrosomia (birthweight ≥ 4500 g). STUDY DESIGN We performed a multicenter, retrospective cohort study of all non-anomalous singletons with SEFW ≥ 4000 g by Registered Diagnostic Medical Sonographers conducted within 14 days of delivery. Cohorts were grouped by time interval between ultrasound and delivery: 0-7 days versus 8-14 days. The detection rate (DR) and false positive rate (FPR) for detection of birthweight (BW) ≥ 4500 g were compared between groups with subgroup analysis for diabetic women. Area under the receiver operator curve (AUC) was calculated to analyze all possible SEFW cutoffs within our cohort. RESULTS A total of 330 patients met inclusion criteria with 250 (75.8 %) having SEFW within 7 days and 80 (24.2 %) with SEFW 8-14 days prior to delivery. The rate of macrosomia was 15.1 % (N = 51). The DR for macrosomia was significantly higher when SEFW was performed within 7 days of delivery compared to 8-14 days among non-diabetic (73.0 % vs 7.1 %; p < 0.001) and diabetic women (76.5 % vs 16.7 %; p = 0.02). There was no significant change in FPR in either group. The AUC for detection of macrosomia was significantly higher when SEFW was performed within 7 days versus 8-14 days (0.89 vs 0.63; p < 0.01). CONCLUSION With SEFW ≥ 4000 g, the detection of BW ≥ 4500 g is significantly higher when the sonographic examination is within 7 days of birth irrespective of maternal diabetes.
Collapse
Affiliation(s)
- Matthew J Bicocca
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - Tran N Le
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Caroline C Zhang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Bonnie Blackburn
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, United States
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
9
|
Dallanora S, Medeiros de Souza Y, Deon RG, Tracey CA, Freitas-Vilela AA, Wurdig Roesch LF, Hack Mendes R. Do probiotics effectively ameliorate glycemic control during gestational diabetes? A systematic review. Arch Gynecol Obstet 2018; 298:477-485. [PMID: 29916111 DOI: 10.1007/s00404-018-4809-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/30/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The aim of this work was to systematically review all studies in which probiotic supplements were used during pregnancy and analyse the effects on GDM. METHODS The data were collected using the medical subheading (MeSH) terms: ("diabetes, gestational"[MeSH Terms] OR ("diabetes"[All Fields] AND "gestational"[All Fields]) OR "gestational diabetes"[All Fields] OR ("gestational"[All Fields] AND "diabetes"[All Fields])) AND ("probiotics"[MeSH Terms] OR "probiotics"[All Fields]). The search included original articles written in English/Portuguese and published between 2012 and 2017. RESULTS Of the 31 articles identified, seven met the inclusion criteria and were included in this review. In these studies, the sample size ranged from 60 to 373 women with GDM, which was between 24 and 40 weeks of pregnancy (second and third trimesters). Results demonstrated that probiotics used during pregnancy in women with GDM may improve glycaemic control and reduce VDL cholesterol, triglycerides, and inflammatory markers. CONCLUSIONS The present systematic review highlights the importance of probiotics for glycemic control and decrease of inflammatory markers in GDM. Further long-term studies should be conducted to elucidate this interaction.
Collapse
Affiliation(s)
- Suelen Dallanora
- Universidade Regional Integrada do Alto Uruguai e das Missões-URI, Frederico Westphalen, Brazil.,Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rúbia Garcia Deon
- Universidade Regional Integrada do Alto Uruguai e das Missões-URI, Frederico Westphalen, Brazil
| | - Clare A Tracey
- University College Dublin, Science Centre South, Dublin, Ireland.,Maastricht University, Maastricht, The Netherlands
| | - Ana Amélia Freitas-Vilela
- Unidade Acadêmica Especial de Ciências da Saúde, Curso de Medicina, Universidade Federal de Goiás/Regional Jataí, Jataí, Brazil
| | | | - Roberta Hack Mendes
- Universidade Regional Integrada do Alto Uruguai e das Missões-URI, Frederico Westphalen, Brazil. .,University College Dublin, Science Centre South, Dublin, Ireland.
| |
Collapse
|