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Seshadri S, Pudhukudi S, Vajiravelu J, Saravanan P, Hyett J, Ram U. Development of a semi-automated tool to measure fetal abdominal wall thickness during ultrasound at 20 weeks' gestation. Int J Gynaecol Obstet 2024; 166:1191-1197. [PMID: 38607348 DOI: 10.1002/ijgo.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 02/27/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To develop a semi-automated tool for measuring fetal abdominal wall thickness (AWT). To validate the software using images captured by other centers and create a nomogram for fetal AWT between 18 and 20 weeks. METHODS A semiautomated tool that measured AWT was developed using images captured at the routine 20-week morphology scan. The software was developed using digital images captured routinely during scans of low-risk women. Inter- and intraobserver reliability was assessed between manual and semi-automated measures. The tool was validated using images acquired from other centers. Linear regression and quadratic polynomials were used to create a nomogram for AWT. RESULTS The semi-automated tool was able to measure AWT in all images. Interoperator reliability was 0.90 and 0.97 (P < 0.05) for manual and semi-automated methods, respectively. Measurement agreement varied between three operators from moderate to excellent (0.77, 0.87, 0.92), with overall agreement being good (0.85). The tool could be successfully applied to 89% of images from other centers. A nomogram was generated for AWT measurements of fetuses at 18-20 weeks in normal, low risk mothers. CONCLUSION Semi-automated measurement of AWT was feasible using images captured during the routine 20-week scan. This approach had lower inter- and intraobserver variability compared to manual measurement.
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Affiliation(s)
| | - Sindhu Pudhukudi
- Mediscan Systems, Chennai, India
- Aster Fetal Medicine, Aster Medcity, Cochin, India
| | | | - Ponnusamy Saravanan
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Jon Hyett
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials. Am J Perinatol 2024; 41:e3383-e3390. [PMID: 38134941 PMCID: PMC11150064 DOI: 10.1055/a-2234-7980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/26/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Infants born large for gestational age (LGA) are at an increased risk of short- and longer-term adverse outcomes. Understanding fetal growth and adiposity and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth. STUDY DESIGN This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials-the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal body mass index (BMI) ranged from 18.5 to ≥40.0 kg/m2. Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks' gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity. RESULTS Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks' gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI. CONCLUSION Infants born LGA had larger fetal biometry measures at all time points from 20 weeks' gestation, compared with infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy or prior to conception. KEY POINTS · Infants born LGA had larger fetal biometry measures from 20 weeks' gestation.. · Infants born LGA had larger fetal adiposity measures.. · Interventions to prevent LGA need to start earlier in pregnancy or prior to conception..
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Affiliation(s)
- Amanda J. Poprzeczny
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Jennie Louise
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- The University of Adelaide, School of Public Health; Adelaide, South Australia, Australia
| | - Andrea R. Deussen
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
| | - Jodie M. Dodd
- The University of Adelaide, The Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
- Department of Perinatal Medicine, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
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Sabir MS, Hassan MM, Malik M, Saleem R, Tariq Z, Zohaib K, Javaid M, Malik AY, Saleem A. Diagnostic Accuracy of Fetal Anterior Abdominal Wall Thickness as an Early Sonographic Sign for Diagnosing Gestational Diabetes. Cureus 2023; 15:e46538. [PMID: 37927742 PMCID: PMC10625453 DOI: 10.7759/cureus.46538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Traditionally, different fetal variable measurements are used in ultrasound to assess fetal growth. Ultrasound can detect abnormal fetal growth. Gestational diabetes mellitus (GDM) is linked to higher fetal obesity as early as 20 weeks of pregnancy. The amount of fetal adipose tissue may be measured by measuring the thickness of the anterior abdominal wall. Measuring the thickness of the fetus's anterior abdominal wall (AAWT) is a straightforward procedure that may be performed alongside standard abdominal circumference measurements. Objectives To check the diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, keeping oral glucose tolerance test as the gold standard. Study design This research was conducted using a cross-sectional analysis. Study place and duration The study was conducted in the Radiology Department at Rawalpindi Medical University and Allied Hospitals from July 10, 2019 to January 9, 2020. Materials and methods Women between the ages of 18 and 45 who had a family history of type 2 diabetes and were at risk for developing GDM were recruited. Exclusions were made for diabetic women, those carrying multiples, and those with autoimmune diseases. The AAWT measurement of the fetus, which included the skin and subcutaneous tissue, was acquired using the traditional anterior cranial view, 2-3 cm lateral to cord insertion. Pregnant patients at risk for GDM underwent screening using an oral glucose tolerance test. Those exhibiting any two abnormal values were diagnosed with GDM. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of fetal AAWT as an early sonographic sign for diagnosing GDM, with the oral glucose tolerance test as the gold standard, were 93.14%, 82.65%, 84.82%, 92.05%, and 88.0%, respectively. Conclusion The study concludes that the diagnostic accuracy of fetal AAWT as an early sonographic indicator for identifying gestational diabetes is notably high.
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Affiliation(s)
| | | | - Moeena Malik
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Rabia Saleem
- Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Zartasha Tariq
- General Medicine, Holy Family Hospital Rawalpindi, Rawalpindi, PAK
| | - Khurram Zohaib
- Internal Medicine, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Maham Javaid
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Adnan Younas Malik
- Internal Medicine and Nephrology, District Headquarter Hospital, Rawalpindi, PAK
| | - Amna Saleem
- Pediatrics and Child Health, Islamic International Medical College Trust (IIMCT)Pakistan Railways Hospital, Rawalpindi, PAK
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Seth I, Aiyappan RK, Singh S, Seth A, Sharma D, K JM, Krishnan V, Seth A, Yadav CM, Jain H. Mid-Trimester Fetal Anterior Abdominal Wall Subcutaneous Tissue Thickness: An Early Ultrasonographic Predictor of Gestational Diabetes Mellitus. Cureus 2023; 15:e34610. [PMID: 36891019 PMCID: PMC9985981 DOI: 10.7759/cureus.34610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to determine whether mid-trimester fetal anterior abdominal wall subcutaneous tissue thickness (FASTT) is an early sonographic predictor of gestational diabetes mellitus (GDM), as well as to study its correlation with maternal glycemic values on GDM screening at 24-28 weeks. Methodology We conducted a prospective, case-control study. FASTT was assessed at anomaly scan in 896 uncomplicated singleton pregnancies. The 75-gram oral glucose tolerance test (OGTT) was done for all included patients at 24-28 weeks. Women diagnosed with GDM were taken as cases and appropriately matched in equal numbers as controls. Statistical analysis was done using SPSS version 20 (IBM Corp., Armonk, NY, USA). Independent-samples t-test, chi-square test, receiver operating characteristic curve, and Pearson's correlation coefficient (r) were performed wherever applicable. Results A total of 93 cases and 94 controls were included. Fetuses of women with GDM had significantly higher mean FASTT at 20 weeks (1.605 ± 0.328 mm vs. 1.222 ± 0.121 mm; p < 0.001). The FASTT cut-off obtained was 1.35 mm (sensitivity = 79.6%, specificity = 87.2%, positive predictive value = 86%, negative predictive value = 81.2%). There was a moderate positive correlation between fasting blood sugar (FBS) and two-hour OGTT values and FASTT (r = 0.332, p < 0.001 and r = 0.399, p < 0.001, respectively). FASTT >1.35 mm had an independent predictive value for GDM and was associated with a 19.608-fold increased risk of GDM. Conclusions FASTT values greater than 1.35 mm at 20 weeks are associated with a significantly increased risk of GDM. In addition, FASTT correlates with FBS and two-hour OGTT at 24-28 weeks and is a simple predictor of GDM at 18-20 weeks.
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Affiliation(s)
- Isha Seth
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | | | - Sunayana Singh
- Obstetrics and Gynaecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Aditya Seth
- Orthopaedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Deepti Sharma
- Obstetrics and Gynaecology, Amrita Hospital, Faridabad, IND
| | - Janu M K
- Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Kochi, IND
| | - Vivek Krishnan
- Perinatology and Foetal Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Arushi Seth
- Medicine, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Chander Mohan Yadav
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Harsh Jain
- Orthopaedics and Rehabilitation, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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Bansal A, Thukral BB, Bagri N, Kanwar A, Khandelwal A, Bajaj B. Correlation of Fetal Anterior Abdominal Wall Thickness and Other Standard Biometric Ultrasound Measurements to Predict Fetal Macrosomia in Gestational Diabetes. J Med Ultrasound 2023; 31:29-34. [PMID: 37180617 PMCID: PMC10173829 DOI: 10.4103/jmu.jmu_57_21] [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: 03/16/2021] [Revised: 10/13/2021] [Accepted: 03/02/2022] [Indexed: 05/16/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common medical conditions affecting pregnancy and significantly increasing the risk for maternal and perinatal complications. The aim of the present study is to study the correlation of fetal anterior abdominal wall thickness (FAAWT) and other standard fetal biometric parameters measured by ultrasound between 36 and 39 weeks of gestation with neonatal birth weight in pregnancies complicated by GDM. Methods Prospective cohort study in a tertiary care center including 100 singleton pregnancies with GDM were subjected to ultrasound between 36 and 39 weeks of gestation. Standard fetal biometry (Biparietal diameter, Head Circumference, Abdominal circumference [AC], and Femur Length) and estimated fetal weight were calculated. FAAWT was measured at AC section and actual neonatal birth weights were recorded after delivery. Macrosomia was defined as an absolute birth weight more than 4000 g regardless of the gestational age. Statistical analysis was done and 95% confidence level was considered significant. Results Among 100 neonates, 16 were macrosomic (16%) and third trimester mean FAAWT was significantly higher in macrosomic babies (6.36 ± 0.5 mm) as compared to nonmacrosomic babies (5.54 ± 0.61 mm) (P < 0.0001). FAAWT >6 mm (Receiver operating characteristic curve derived) provided a sensitivity of 87.5%, specificity of 75%, positive predictive value of 40%, and negative predictive value (NPV) of 96.9% for prediction of macrosomia. While other standard fetal biometric parameters did not correlate well with actual birth weight in macrosomic neonates, only FAAWT was found to have statistically significant correlation (correlation coefficient of 0.626, P = 0.009). Conclusion The FAAWT was the only sonographic parameter to have a significant correlation with neonatal birth weight in macrosomic neonates of GDM mothers. We found a high sensitivity (87.5%), specificity (75%), and NPV (96.9%) suggesting that FAAWT < 6 mm can rule out macrosomia in pregnancies with GDM.
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Affiliation(s)
- Ashish Bansal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Brij Bhushan Thukral
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neha Bagri
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Address for correspondence: Dr. Neha Bagri, Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India. E-mail:
| | - Ankita Kanwar
- Department of Radiodiagnosis, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Ayush Khandelwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Bindu Bajaj
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness. Int J Nephrol 2022; 2022:3573963. [PMID: 35812800 PMCID: PMC9262542 DOI: 10.1155/2022/3573963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives. To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound. Methods. This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks’ gestation at a tertiary-care fetal assessment unit were reviewed. “Cases” comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups. Results. There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8–8.1) compared to 11.4 mm (95% CI 10.6–12.7) in controls (
); the mean renal thickness among cases was 8.1 mm (95% CI 7.9–8.2) compared to 11.5 mm (95% CI 10.7–12.9) in controls (
). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age (
). Conclusions. Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring.
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Lam P, Mein BJ, Benzie RJ, Ormerod JT, Robledo KP, Hibbert EJ, Nanan RK. Maternal diabetes independent of BMI is associated with altered accretion of adipose tissue in large for gestational age fetuses. PLoS One 2022; 17:e0268972. [PMID: 35639703 PMCID: PMC9154097 DOI: 10.1371/journal.pone.0268972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
Aim
To analyse the effects of maternal diabetes mellitus (DM) and body mass Index (BMI) on central and peripheral fat accretion of large for gestational age (LGA) offspring.
Methods
This retrospective study included LGA fetuses (n = 595) with ultrasound scans at early (19.23 ± 0.68 weeks), mid (28.98 ± 1.62 weeks) and late (36.20 ± 1.59 weeks) stages of adipogenesis and measured abdominal (AFT) and mid-thigh (TFT) fat as surrogates for central and peripheral adiposity. Women were categorised according to BMI and DM status [pre-gestational (P-DM; n = 59), insulin managed (I-GDM; n = 132) and diet managed gestational diabetes (D-GDM; n = 29)]. Analysis of variance and linear regressions were applied.
Results
AFT and TFT did not differ significantly between BMI categories (normal, overweight and obese). In contrast, AFT was significantly higher in pregnancies affected by D-GDM compared to non-DM pregnancies from mid stage (0.44 mm difference, p = 0.002) and for all DM categories in late stage of adipogenesis (≥ 0.49 mm difference, p < 0.008). Late stage TFT accretion was higher than controls for P-DM and I-GDM but not for D-GDM (0.67 mm difference, p < 0.001; 0.49 mm difference, p = 0.001, 0.56 mm difference, p = 0.22 respectively). In comparison to the early non-DM group with an AFT to TFT ratio of 1.07, the I-GDM group ratio was 1.25 (p < 0.001), which normalised by 28 weeks becoming similar to control ratios.
Conclusions
DM, independent of BMI, was associated with higher abdominal and mid-thigh fat accretion in fetuses. Use of insulin improved central to peripheral fat ratios in fetuses of GDM mothers.
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Affiliation(s)
- Penny Lam
- Christopher Kohlenberg Department of Perinatal Ultrasound, Nepean Hospital, Penrith, New South Wales, Australia
- * E-mail:
| | - Brendan J. Mein
- Christopher Kohlenberg Department of Perinatal Ultrasound, Nepean Hospital, Penrith, New South Wales, Australia
| | - Ronald J. Benzie
- Christopher Kohlenberg Department of Perinatal Ultrasound, Nepean Hospital, Penrith, New South Wales, Australia
| | - John T. Ormerod
- School of Mathematics and Statistics, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, Victoria, Australia
| | - Kristy P. Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Emily J. Hibbert
- Department of Endocrinology and Diabetes, Division of Medicine, The University of Sydney Nepean Clinical School, University of Sydney, Penrith, New South Wales, Australia
| | - Ralph K. Nanan
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre–Nepean Clinical School, University of Sydney, Penrith, New South Wales, Australia
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O'Dwyer V, Russell NM, McDonnell B, Sharkey L, Mulcahy C, Higgins MF. Antenatal prediction of fetal macrosomia in pregnancies affected by maternal pre-gestational diabetes. J Matern Fetal Neonatal Med 2021; 35:7412-7416. [PMID: 34229553 DOI: 10.1080/14767058.2021.1949447] [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
AIMS Higher rates of fetal macrosomia may occur in infants of women with pre-gestational diabetes compared with non-diabetic controls. Antenatal predication of fetal macrosomia remains challenging. Ultrasound over-estimated fetal weight could result in over-classification of fetuses as macrosomic with corresponding inappropriate clinical interventions. Previously we had studied a measurement - the anterior abdominal wall measurement (AAW) - to predict fetal macrosomia in fetal estimation of weight. The purpose of the study was to study whether specific third trimester ultrasound measurements with measures of glycaemic control (HbA1c) predicted macrosomia in babies born to women with pre-gestational diabetes. In particular, a new variant of this measurement (fetal anterior abdominal wall thickness (AAW), abdominal circumference (AC) ratio: AAW:AC) was investigated. METHODS This was a prospective cohort study in a tertiary referral maternity hospital. Serial growth scans including measurement of AAW and AC: AAW ratio was performed at 30, 33- and 36-weeks' gestation. Birth-weight data was collected, and macrosomia was defined as >90th centile based on gestational age and gender of the baby. Serial HbA1c as measured at the first antenatal visit, 14, 20- and 36-weeks' gestation were reported for this study. RESULTS Of the 416 pregnancies analyzed, mean maternal age was 33.3 years. One in five women were primigravida's. The mean birthweight was 3548 g (+/- 581 g), of which 142 (34%) babies were classified as macrosomic. The median gestational age at delivery was 383 weeks (314 - 402 weeks). There were 37 (9%) babies born preterm at <37 weeks' gestation. Mean AC measurements in fetuses that would be born with macrosomia compared with those with a non-macrosomic birth weight were 282 mm vs. 266 mm at 30 weeks, 318.3 mm vs. 297 mm at 33 weeks and 350 mm vs. 325 mm at 36 weeks' gestation (all p < .001). Mean AAW measurements in macrosomic fetuses compared with normal size fetuses were 3.7 mm vs. 3.3 mm at 30 weeks, 4.9 mm vs 4.3 mm at 33 weeks and 5.9 mm vs. 5.3 mm at 36 weeks' gestation (all p < .001). The mean AC: AAW was 0.01 for both normal and macrosomic fetuses at 30 weeks. There was no clinical or statistical difference in AC:AAW ratios between non-macrosomic and macrosomic infants. Binary logistic regression showed that AC at 36 weeks was most predictive of macrosomia (76.5%), followed by AAW at 30 weeks (68.5%). Using a combination of HbA1c booking, 14, 20, 36 weeks and AAW 30, 33, 36 weeks and AC 30, 33, 36 weeks predicted macrosomia in 80.9%. The ratio of AC: AAW did not act as a useful antenatal clinical predictor of macrosomia at birth. CONCLUSIONS Abdominal circumference at 36 weeks was the single best predictor of fetal macrosomia. A combined model of HbA1c, AC and AAW was the best antenatal predictor of macrosomia, with intriguing clinical possibilities in the possible prevention of maternal and fetal complications of macrosomia.
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Affiliation(s)
- V O'Dwyer
- Obstetrics and Gynecology, National Maternity Hospital, Dublin, Ireland
| | - N M Russell
- Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - B McDonnell
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - L Sharkey
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - C Mulcahy
- Midwifery, National Maternity Hospital, Dublin, Ireland
| | - M F Higgins
- Obstetrics and Gynecology, National Maternity Hospital, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Lertvutivivat S, Sunsaneevithayakul P, Ruangvutilert P, Boriboonhirunsarn D. Fetal anterior abdominal wall thickness between gestational diabetes and normal pregnant women. Taiwan J Obstet Gynecol 2021; 59:669-674. [PMID: 32917316 DOI: 10.1016/j.tjog.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare fetal anterior abdominal wall thickness (AAWT) between women with and without GDM during third trimester and to determine accuracy of AAWT to predict large for gestational age (LGA) infants. MATERIALS AND METHODS A total of 250 pregnant women, including 125 women with GDM and 125 women without GDM, were enrolled. Tansabdominal ultrasonographic examinations were performed at 28-30, 32-34 and 36-38 weeks. In addition to standard fetal biometries, AAWT was measured. Patient characteristics and ultrasonographic measurements were compared between groups. Sensitivity and specificity of AAWT for identifying LGA were evaluated. RESULTS While standard fetal biometries were comparable, mean fetal AAWT in GDM women were significantly higher than those without GDM at 28-30 weeks (2.8 ± 0.8 vs. 2.6 ± 0.6, p = 0.006) and 32-34 weeks (4.0 ± 0.9 vs. 3.5 ± 0.8, p = 0.042). LGA infants had significantly higher fetal AAWT at each time point only in GDM women. Using cut off values of AAWT of ≥2.0, 3.0, and 4.0 mm at 28-30, 32-34, and 36-38 weeks, sensitivity for LGA diagnosis in GDM women were 94.4%, 93.9%, and 89.3%, respectively. The use of abdominal circumference (AC) at >90th percentile showed lower sensitivity but higher specificity, regardless of GDM status. Combination of both measurements increased sensitivity to approximately 90% or higher in every time point, especially among GDM women. CONCLUSION Significant increase in fetal AAWT was observed in GDM women at 28-30 and 32-34 weeks. Fetal AAWT significantly increased among LGA infants and had higher sensitivity than AC in identifying LGA during third trimester. In GDM women at 28-30 weeks, AAWT ≥2.0 mm and AC >90th percentile had 97.2% sensitivity for LGA diagnosis.
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Affiliation(s)
- Supapen Lertvutivivat
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Prasert Sunsaneevithayakul
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Pornpimol Ruangvutilert
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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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.
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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
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11
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Isabey EP, Pylypjuk CL. The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes. J Diabetes Res 2021; 2021:5544599. [PMID: 34195292 PMCID: PMC8184339 DOI: 10.1155/2021/5544599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. METHODS This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks' gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. RESULTS 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23). There was strong interobserver correlation of AWT measurements (r = 0.838; p < 0.00001). The strongest association with intrapartum complications was birthweight (p = 0.003): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001). CONCLUSIONS There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.
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Affiliation(s)
- E. Paige Isabey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada R3A 1R9
| | - Christy L. Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada R3A 1R9
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada R3E 3P4
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12
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Weschenfelder F, Baum N, Lehmann T, Schleußner E, Groten T. The Relevance of Fetal Abdominal Subcutaneous Tissue Recording in Predicting Perinatal Outcome of GDM Pregnancies: A Retrospective Study. J Clin Med 2020; 9:E3375. [PMID: 33096839 PMCID: PMC7594040 DOI: 10.3390/jcm9103375] [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] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
Guidelines on the management of gestational diabetes (GDM) instruct physicians to involve ultrasound-based monitoring of fetal growth in addition to blood glucose. So far, glucose control besides clinical parameters like maternal body mass index (BMI) and gestational weight gain have been shown to predict neonatal outcome. We aimed to evaluate the discriminative ability of fetal abdominal subcutaneous tissue (FAST) in addition to standard ultrasound parameters like abdominal circumference (AC) and estimated fetal weight (EFW) for perinatal complications like large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, mode of delivery and admission to neonatal intensive care unit (NICU). Ultrasound data and neonatal outcome was collected of 805 GDM cases from 2012 to 2016: 3205 FAST, 3195 AC-measurements and 3190 EFW calculations were included. AC, EFW and FAST increased linear with gestational age. Combining ultrasound and clinical parameters improved predictive power for LGA. In the subgroup where fetuses grow with an AC > 75th additional adding of FAST to standard ultrasound parameters increased predictive power for hypoglycemia. Our results confirm inclusion of ultrasound parameters to be beneficial in monitoring GDM pregnancies. Additional FAST determination revealed to be of potential clinical relevance in the subgroup AC > 75th percentile.
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Affiliation(s)
| | - Nadin Baum
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, 07747 Jena, Germany;
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany; (F.W.); (N.B.); (E.S.)
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13
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Madendag Y, Aksoy U, Col Madendag I, Aksoy H. Fetal front-abdominal wall thickness in the second trimester as a predictor of abnormal fetal growth. J Matern Fetal Neonatal Med 2020; 35:1162-1168. [PMID: 32208785 DOI: 10.1080/14767058.2020.1743666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Worldwide, approximately 9% of infants have a birth weight ≥4000 g, who are defined as fetal macrosomia, with wide variations between countries. Another form of abnormal fetal growth is fetal growth restriction. Infants with low birth weight (LBW) for their gestational age are primarily categorized as either small for gestational age (SGA) or fetal (intrauterine) growth restriction (FGR). All forms of abnormal fetal growth have high morbidity rates of neonatal. Therefore, diagnosis of abnormal fetal growth as early as possible is crucial for optimal clinical care. The measurement of fetal front-abdominal wall thickness (FAWT) is an easy examination. We conducted this study, wondering whether FAWT can predict birth weight or can determine LGA/macrosomia and/or LBW infants in advance.Methods: This longitudinal cohort study was done in a tertiary center between September 2016 and September 2019. In total, 768 pregnant women with who attended our clinic for oral glucose tolerance test (OGTT) screening between the 26th and 28th weeks of gestation were included in this study. A total of 768 patients were evaluated in the present study. However, 186 of them were excluded in the follow-up of the study because they met the exclusion criteria or they gave birth in another hospital. Eventually, 582 pregnant women were included, with 57 in the LBW group, 461 in the AGA group, and 64 in the LGA group. In addition, 55 fetuses in the LGA group were determined to be macrosomic (birth weight > 4000 g). The FAWT and classic fetal biometric measurements, such as BPD, AC, FL, and EFW, were compared between the AGA group and the macrosomic infants. Statistical analysis was performed to compare the AGA group and the macrosomic infants group. There were no macrosomic infants in the AGA group, so this was used as the control group.Results: There were no significant differences between the groups for maternal age, gravidity, parity, gestational age on the day of the examination, and gestational age at birth. The mean FAWT was significantly thinner in the SGA group than in the appropriate for gestational age (AGA) group (3.4 versus 3.9 mm, respectively, p < .001), while it was significantly thicker in the LGA group than in the AGA group (4.1 versus 3.9 mm, respectively, p < .001).Conclusion: FAWT measurement can provide more information and may be more sensitive toward fetal nutrition and growth than the AC value during the second trimester. Some benefits can be gained through the measurement of FAWT at the end of the second trimester. FAWT measurements can be used in obstetrical practice with a similar performance in predicting the LGA and macrosomic infant like AC and EFW.
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Affiliation(s)
- Y Madendag
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - U Aksoy
- Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey
| | - I Col Madendag
- Department of Obstetrics and Gynecology, Health Sciences University Kayseri City Hospital, Kayseri, Turkey
| | - H Aksoy
- Department of Obstetrics and Gynecology, Health Sciences University Kayseri City Hospital, Kayseri, Turkey
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14
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Cesnaite G, Domza G, Ramasauskaite D, Volochovic J. The Accuracy of 22 Fetal Weight Estimation Formulas in Diabetic Pregnancies. Fetal Diagn Ther 2019; 47:54-59. [PMID: 31195392 DOI: 10.1159/000500452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The objective of this study was to estimate the accuracy of 22 fetal weight estimation formulas in diabetic pregnancies uncomplicated and complicated by fetal macrosomia. METHODS Retrospectively collected data of 317 pregnancies complicated by gestational diabetes mellitus and 78 cases of fetal macrosomia were used in this study. Study inclusion criteria were women diagnosed with gestational diabetes mellitus, full-term singleton pregnancy, and an interval from the ultrasound to delivery of ≤7 days. The estimated fetal weight was calculated using 22 formulas. The mean absolute percentage error (MAPE) and two-way random interclass correlation coefficient were chosen for statistical analysis. RESULTS In the group of gestational diabetes, MAPE ranged from 8.43 ± 10.17 to 54.01 ± 9.50%. Most of the formulas showed a tendency to estimate a lower fetal weight in comparison to the actual birth weight. In the group of fetal macrosomia, the correlations were poor. Only three formulas reached the threshold of MAPE <10%. CONCLUSIONS The formula by Hsieh might be considered the best for fetal weight estimation in diabetic pregnancies. The combination of the best formulas might improve the accuracy of estimation. None of the formulas were accurate enough to predict fetal macrosomia.
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Affiliation(s)
- Gerda Cesnaite
- Vilnius University Faculty of Medicine, Vilnius, Lithuania,
| | - Gintautas Domza
- Clinic of Obstetrics and Gynecology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Clinic of Obstetrics and Gynecology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jelena Volochovic
- Clinic of Obstetrics and Gynecology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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15
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Köşüş N, Köşüş A. Can fetal abdominal visceral adipose tissue and subcutaneous fat thickness be used for correct estimation of fetal weight? A preliminary study. J OBSTET GYNAECOL 2019; 39:594-600. [PMID: 31010342 DOI: 10.1080/01443615.2018.1530971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess the accuracy of a new formula for the calculation of an estimated fetal weight (EFW) and to evaluate value of fetal visceral adipose tissue (VAT) and abdominal subcutaneous fat (SF) thickness on the prediction of birth weight. In this prospective study, fetal biometry, EFW, fetal VAT and SF thickness were measured in low-risk 37-41 gestational weeks pregnant women by ultrasonography. The linear regression analysis was performed to investigate the relationship between birth weight and obstetric measurements. It was found that the most important factors in the prediction of a birth weight were the abdominal circumference (AC), SF and VAT. The new formula for EFW was EFW=-2748.622+13.811*AC+56.795*SF+17.913*VAT According to the Hadlock 3 and the new formula, 92% and 95% of all fetal weight estimations were within 10% of actual birth weight, respectively. Measurement of VAT and SF thickness in prediction of fetal weight could reduce a weight estimation error. Impact statement What is already known on this subject? An accurate prediction of fetal weight during gestation provides useful information for assessing the fetal and newborn health status. As the detection of growth abnormalities is vital, there is a need for a reliable method of assessing birth weight during labour. Unfortunately, although different methods are available, a simple, quick and reliable method of assessing birth weight is still in debate. Fetal visceral adipose (VAT) tissue measurement is a new method which could be used for the correct estimation of fetal weight. Like adults, the VAT and subcutaneous fat tissue (SF) thickness could be correlated with the weight and body-mass index. What do the results of this study add? It was found that SF and VAT are important factors in the prediction of birth weight, like the abdominal circumference (AC). What are the implications of these findings for clinical practice and/or further research? The measurement of VAT and SF thickness in prediction of fetal weight could reduce a weight estimation error.
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Affiliation(s)
- Nermin Köşüş
- a Department of ObGyn. Private Practice , Ankara , Turkey
| | - Aydın Köşüş
- a Department of ObGyn. Private Practice , Ankara , Turkey
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16
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Bartels HC, O'Connor C, Segurado R, Mason O, Mehegan J, Geraghty AA, O'Brien E, Walsh J, McAuliffe F. Fetal growth trajectories and their association with maternal and child characteristics. J Matern Fetal Neonatal Med 2019; 33:2427-2433. [PMID: 30614328 DOI: 10.1080/14767058.2018.1554041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: The growth of the fetus is a complex process, influenced by genetic and environmental factors. Longitudinal patterns of fetal growth are required to fully understand this process, however to date, a paucity of data exists in this area.Objective: To identify fetal growth trajectories in-utero and to assess their association with maternal and child characteristics up to 5 years postnatal.Methods: Data from 781 mother-child pairs from the ROLO longitudinal birth cohort study were analyzed. The ROLO study was a randomized control trial of a low glycemic index diet in pregnancy to prevent recurrence of macrosomia. Fetal ultrasound measurements were recorded at 20 and 34 weeks gestation, and birth weight was recorded. Abdominal circumference (AC), weight (fetal weight, or birth weight), a standardized proxy for length (femur length or birth length, individually standardized), and AC:length ratio were examined for trajectory classes using latent class trajectory mixture models. Two-, three-, four-, and five-class models were evaluated for fit, using a linear (first order) trajectory over three time-points. ANOVA and chi-square tests were applied to test associations between trajectory membership and maternal and child characteristics up to age 5.Results: For AC, two fetal growth trajectories were identified, with 29% of participants on a "slow" trajectory and 71% on a "fast" trajectory. Those on a fast trajectory had higher rates of maternal impaired glucose tolerance (28.7 versus 16.5%, p<.001) and higher rates of mean child 5-year body mass index (BMI) centiles (64th versus 58th centile, p<.05) compared to those on the slow trajectory. For estimated fetal weight, four trajectories were identified, with 4% on a "very-slow" trajectory, 63% in a "moderate-slow" trajectory, 30% in a "moderate-fast" trajectory and 3% on a "very-fast" trajectory. Mothers with a fetus on the fastest trajectory had higher antenatal serum glucose levels (p<.05), and were more likely to deliver by cesarean section (59.1 versus 20%, p<.001). At 5 years of age, children on the fastest growth trajectory had the highest mean BMI centile (86th versus 60th centile, p<.05).Conclusions: This study shows that specific fetal growth trajectories may be associated with maternal serum glucose concentrations during pregnancy, mode of delivery and child BMI at 5 years of age. Diet and lifestyle measures that target maternal glucose levels during pregnancy may have lifelong benefits for children's BMI. Identifying those on an accelerated growth trajectory during fetal life provides a unique opportunity for antenatal and infant interventions that may have long-lasting health benefits.
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Affiliation(s)
- Helena C Bartels
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Clare O'Connor
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Olivia Mason
- Centre for Support and Training in Analysis and Research and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland, Dublin, Ireland
| | - John Mehegan
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Eileen O'Brien
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - Jennifer Walsh
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
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17
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Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial. BJOG 2018; 125:1558-1566. [PMID: 29782075 DOI: 10.1111/1471-0528.15288] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the mediating effect of maternal gestational diabetes on fetal biometry and adiposity measures among overweight or obese pregnant women. DESIGN Secondary analysis of the LIMIT randomised trial. SETTING Public hospitals, metropolitan Adelaide, South Australia. POPULATION Pregnant women with body mass index (BMI) ≥25 kg/m2 and singleton gestation. METHODS Fetal ultrasound measures at 36 weeks of gestation and baseline BMI from women randomised to the LIMIT trial Standard Care group (n = 912 women) were used to conduct causal mediation analyses using regression-based methods. MAIN OUTCOMES MEASURES Ultrasound measures of fetal biometry and adiposity at 36 weeks of gestation. RESULTS Increased maternal BMI was associated with increased measures of fetal head circumference [direct (unmediated) effect 0.18 (95% CI: 0.05-0.31), P = 0.005; total effect 0.17 (95% CI: 0.02-0.31), P = 0.018], abdominal circumference [direct effect 0.26 (95% CI: 0.11-0.41), P = 0.001; total effect 0.26 (95% CI: 0.11-0.42), P = 0.001] and estimated fetal weight [direct effect 0.22 (95% CI: 0.08-0.35), P = 0.002; total effect 0.22 (95% CI: 0.08-0.35), P = 0.002], with no evidence of mediation by treated gestational diabetes. There was no apparent association between maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes. CONCLUSIONS We show an important association between increased maternal BMI and fetal growth, not mediated by treated gestational diabetes. There was no association between increased maternal BMI and fetal adiposity measures, or mediation by treated gestational diabetes. Whether these findings represent 'saturation' in the effect of maternal BMI on fetal growth or the effect of treatment of GDM is unclear. FUNDING This project was funded by a 4-year project grant from the National Health and Medical Research Council (NHMRC), Australia (ID 519240); The Channel 7 Children's Research Foundation, South Australia; and the US National Institutes of Health (R01 HL094235-01). TWEETABLE ABSTRACT Increased fetal growth associated with maternal obesity is not mediated by gestational diabetes.
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Affiliation(s)
- A J Poprzeczny
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Elizabeth, SA, Australia
| | - J Louise
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - A R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - J M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, Adelaide, SA, Australia
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18
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Giza SA, Miller MR, Parthasarathy P, de Vrijer B, McKenzie CA. Comparison of modified two-point dixon and chemical shift encoded MRI water-fat separation methods for fetal fat quantification. J Magn Reson Imaging 2018; 48:274-282. [DOI: 10.1002/jmri.25929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Stephanie A. Giza
- Department of Medical Biophysics; Western University; London Ontario Canada
| | - Michael R. Miller
- Division of Maternal, Fetal and Newborn Health; Children's Health Research Institute; London Ontario Canada
- Department of Paediatrics; Western University; London Ontario Canada
| | | | - Barbra de Vrijer
- Division of Maternal, Fetal and Newborn Health; Children's Health Research Institute; London Ontario Canada
- Department of Obstetrics and Gynaecology; Western University; London Ontario Canada
| | - Charles A. McKenzie
- Department of Medical Biophysics; Western University; London Ontario Canada
- Division of Maternal, Fetal and Newborn Health; Children's Health Research Institute; London Ontario Canada
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19
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Abduljalil K, Johnson TN, Rostami-Hodjegan A. Fetal Physiologically-Based Pharmacokinetic Models: Systems Information on Fetal Biometry and Gross Composition. Clin Pharmacokinet 2017; 57:1149-1171. [DOI: 10.1007/s40262-017-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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21
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Grivell RM, Yelland LN, Deussen A, Crowther CA, Dodd JM. Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial. BJOG 2016; 123:233-43. [PMID: 26841216 DOI: 10.1111/1471-0528.13777] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report the influence of maternal overweight and obesity on fetal growth and adiposity and effects of an antenatal dietary and lifestyle intervention among these women on measures of fetal growth and adiposity as secondary outcomes of the LIMIT Trial. DESIGN Randomised controlled trial. SETTING Public maternity hospitals in metropolitan Adelaide, South Australia. POPULATION Pregnant women with a body mass index ≥ 25 kg/m(2), and singleton gestation between 10(+0) and 20(+0) weeks. METHODS Women were randomised to Lifestyle Advice or continued Standard Care and offered two research ultrasound scans at 28 and 36 weeks of gestation. MAIN OUTCOME MEASURES Ultrasound measures of fetal growth and adiposity. RESULTS For each fetal body composition parameter, mean Z-scores were substantially higher when compared with population standards. Fetuses of women receiving Lifestyle Advice demonstrated significantly greater mean mid-thigh fat mass, when compared with fetuses of women receiving Standard Care (adjusted difference in means 0.17; 95% CI 0.02-0.32; P = 0.0245). While subscapular fat mass increased between 28 and 36 weeks of gestation in fetuses in both treatment groups, the rate of adipose tissue deposition slowed among fetuses of women receiving Lifestyle Advice, when compared with fetuses of women receiving Standard Care (P = 0.0160). No other significant differences were observed. CONCLUSIONS These findings provide the first evidence of changes to fetal growth following an antenatal dietary and lifestyle intervention among women who are overweight or obese.
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Affiliation(s)
- R M Grivell
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
| | - L N Yelland
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - A Deussen
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - C A Crowther
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - J M Dodd
- School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
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Scifres CM, Feghali M, Dumont T, Althouse AD, Speer P, Caritis SN, Catov JM. Large-for-Gestational-Age Ultrasound Diagnosis and Risk for Cesarean Delivery in Women With Gestational Diabetes Mellitus. Obstet Gynecol 2016; 126:978-986. [PMID: 26444129 DOI: 10.1097/aog.0000000000001097] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the accuracy of a large-for-gestational-age (LGA) ultrasound diagnosis and the subsequent risk for cesarean delivery associated with ultrasound diagnosis of LGA among women with gestational diabetes mellitus. METHODS This was a retrospective cohort study of 903 women with GDM who delivered after 36 weeks of gestation with an ultrasound-estimated fetal weight within 31 days of delivery. Delivery outcomes were compared between women with an ultrasound diagnosis of LGA and a non-LGA ultrasound diagnosis. RESULTS Based on ultrasound assessments, we identified 248 women with an LGA fetus and 655 women with a non-LGA fetus. Among women with an LGA ultrasound diagnosis, 56 of 248 (22.6%) delivered an LGA neonate, whereas, of women with a non-LGA ultrasound diagnosis, 18 of 655 (2.8%) delivered an LGA neonate. Ultrasound diagnosis of LGA was associated with increased risk for cesarean delivery (adjusted odds ratio [OR] 3.13, 95% confidence interval [CI] 2.10-4.67, P<.001) after adjusting for relevant covariates. Stratified analyses demonstrated that ultrasound diagnosis of LGA was associated with an increased risk for cesarean delivery whether the birth weight was between 2,500 and 3,499 g (OR 2.82, 95% CI 1.62-4.84, P<.001) or between 3,500 and 4,500 g (OR 3.47, 95% CI 2.06-5.88, P<.001). CONCLUSION Ultrasonography significantly overestimates the prevalence of LGA in women with gestational diabetes mellitus, and an ultrasound diagnosis of LGA is associated with an increased risk for cesarean delivery independent of birth weight. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christina M Scifres
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, and the Harold Hamm Diabetes Center, Oklahoma City, Oklahoma; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Walsh JM, Segurado R, Mahony RM, Foley ME, McAuliffe FM. The Effects of Fetal Gender on Maternal and Fetal Insulin Resistance. PLoS One 2015; 10:e0137215. [PMID: 26368559 PMCID: PMC4569192 DOI: 10.1371/journal.pone.0137215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/13/2015] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Gender plays a role in the development of a number of cardiovascular and metabolic diseases and it has been suggested that females may be more insulin resistant in utero. We sought to assess the relationship between infant gender and insulin resistance in a large pregnancy cohort. STUDY DESIGN This is a secondary analysis of a cohort from the ROLO randomized control trial of low GI diet in pregnancy. Serum insulin, glucose and leptin were measured in early pregnancy and at 28 weeks. At delivery cord blood C-peptide and leptin were measured. A comparison of maternal factors, fetal biometry, insulin resistance and leptin was made between male and female offspring. A multivariate regression model was built to account for the possible effects of maternal BMI, birthweight and original study group assignment on findings. RESULTS A total of 582 women were included in this secondary analysis, of whom 304 (52.2%) gave birth to male and 278 (47.8%) gave birth to female infants. Compared to male infants at birth, female infants were significantly lighter, (3945 ± 436 vs. 4081± 549g, p<0.001), shorter in length (52.36 ± 2.3 vs. 53.05 ± 2.4cm, p<0.001) and with smaller head circumferences (35.36 ± 1.5 vs. 36.10 ± 1.1cm, p<0.001) than males. On multiple regression analysis, women pregnant with female fetuses were less insulin resistant in early pregnancy, i.e. had lower HOMA indices (B = -0.19, p = 0.01). Additionally female fetuses had higher concentrations of both cord blood leptin and C-peptide at birth when compared to male offspring (B = 0.38, p<0.001 and B = 0.31, p = 0.03 respectively). CONCLUSION These findings suggest gender is a risk factor for insulin resistance in-utero. Additionally, carrying a female fetus decreases the risk of insulin resistance in the mother, from as early as the first trimester.
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Affiliation(s)
- Jennifer M. Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ricardo Segurado
- CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | | | - Michael E. Foley
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
- * E-mail:
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Aksoy H, Aksoy Ü, Yücel B, Saygi Özyurt S, Aydın T, Alparslan Babayiğit M. Fetal anterior abdominal wall thickness may be an early ultrasonographic sign of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2015; 29:2028-32. [DOI: 10.3109/14767058.2015.1072164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Walsh JM, Wallace M, Brennan L, McAuliffe FM. Early pregnancy maternal urinary metabolomic profile and later insulin resistance and fetal adiposity. J Matern Fetal Neonatal Med 2014; 28:1697-700. [DOI: 10.3109/14767058.2014.966672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aksoy H, Aksoy U, Açmaz G, Tutuş S. The effect of impaired 50-gram oral glucose challenge test on fetal abdominal wall thickness. Diabetes Metab Res Rev 2014; 30:570-4. [PMID: 24353250 DOI: 10.1002/dmrr.2511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/21/2013] [Accepted: 11/26/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with impaired 50-g oral glucose challenge test (OGCT) have not been investigated for fetal anterior abdominal wall thickness until now. We aimed to investigate patients with impaired 50-g OGCT, but not gestational diabetes and match them with healthy uneventful pregnant participants for anterior abdominal wall thickness, estimated fetal weight, fetal gender, biparietal diameter, femur length and abdominal circumference. METHODS A total of 99 pregnant women between 26 and 28 weeks of gestation were enrolled in the study. These patients were divided into two groups according to their 50-g OGCT results. Fifty-one pregnant women with uncomplicated healthy singleton pregnancies constituted our control group, and 48 singleton pregnant women with impaired 50-g OGCT but normal 100-g oral glucose tolerance test constituted our study group. RESULTS We detected statistically significant high body mass index in impaired 50-g glucose test group. Biparietal diameter, femur length, abdominal circumference and estimated fetal weight values were not significantly different between groups; however, anterior abdominal wall thickness value was significantly width in impaired 50-g glucose test group. Moreover, there were no statistically significant differences between two groups for gender of fetuses. CONCLUSION Impaired 50-g glucose test in pregnancy is related not only to increased maternal body mass index but also to fetal fat distribution. Although fetal abdominal circumference measurement and estimated fetal weight were not different between study and control group, increased anterior abdominal wall thickness can be detected in impaired 50-g OGCT group.
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Affiliation(s)
- Hüseyin Aksoy
- Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey
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Walsh JM, McAuliffe FM. Impact of maternal nutrition on pregnancy outcome--does it matter what pregnant women eat? Best Pract Res Clin Obstet Gynaecol 2014; 29:63-78. [PMID: 25438930 DOI: 10.1016/j.bpobgyn.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 01/06/2023]
Abstract
Pregnancy presents a unique époque in life with considerable potential to influence not only maternal health but also the health of the next generation. Nutritional interventions in pregnancy can influence maternal, foetal and infant health. This chapter describes the findings of a large randomised controlled trial on the impact of a low glycaemic index diet on maternal and foetal health and discusses areas of future research in this important area.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Walsh JM, McGowan CA, Mahony RM, Foley ME, McAuliffe FM. Obstetric and metabolic implications of excessive gestational weight gain in pregnancy. Obesity (Silver Spring) 2014; 22:1594-600. [PMID: 24715415 DOI: 10.1002/oby.20753] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/04/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare maternal characteristics, obstetric outcomes and insulin resistance in a cohort of women subdivided into those who did and those who did not exceed the Institute of Medicine (IOM) gestational weight gain guidelines. METHODS This is a prospective study of 621 women without diabetes. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. Ultrasound at 34 weeks assessed fetal anthropometry including abdominal wall width (AAW). At delivery birthweight was recorded and fetal glucose, C-peptide and leptin measured in cord blood. Insulin resistance was calculated using the HOMA equation. Outcomes in those who did and did not exceed IOM guidelines were compared. RESULTS Overall, 267 women (43%) exceeded IOM guidelines and 354 (57%) did not. On 34-week ultrasound women with excessive weight gain had higher fetal weights (2681 ± 356 g vs. 2574 ± 331, P = 0.001) and fetal adiposity (AAW) (5.29 ± 1.3 vs. 4.8 ± 1.2, P = 0.001). Infant birthweight and birthweight centiles were also higher in those who exceeded the guidelines. There was no difference between the two groups in maternal insulin resistance in early pregnancy, but by 28 weeks those with excessive weight gain had higher maternal HOMA indices and higher maternal leptin concentrations. CONCLUSION Excessive maternal gestational weight gain has significant implications for infant growth and adiposity, with potential implications for later adult health.
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Affiliation(s)
- Jennifer M Walsh
- UCD Department of Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Leptin, fetal growth and insulin resistance in non-diabetic pregnancies. Early Hum Dev 2014; 90:271-4. [PMID: 24703297 DOI: 10.1016/j.earlhumdev.2014.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 02/17/2014] [Accepted: 03/08/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Interrogation of the association between leptin, insulin resistance and fetal growth may provide a biological link for the fetal programming of later metabolic health. AIMS Our aim was to clarify the relationship between maternal and fetal leptin, insulin resistance and fetal growth. STUDY DESIGN Maternal leptin, glucose and insulin were measured in early pregnancy and at 28weeks and the HOMA index calculated. At 34weeks, ultrasound scan assessed fetal weight and adiposity (abdominal wall width). At delivery birthweight was recorded and cord blood analyzed for fetal c-peptide and leptin. Analysis was performed using a multivariate linear regression model. SUBJECTS 574 non-diabetic pregnant women. OUTCOME MEASURES Fetal growth and maternal and fetal insulin resistance. RESULTS On multivariate analysis a relationship was identified between maternal and fetal leptin concentrations at each time point and maternal body mass index. Maternal leptin was related to insulin resistance in early pregnancy (β=0.15, p=0.02) and at 28week gestation (β=0.27, p<0.001). Fetal insulin resistance correlated with maternal leptin in early pregnancy (β=0.17, p=0.004); at 28weeks (β=0.12, p=0.05), and with leptin in cord blood (r=0.28, p<0.001). Fetal weight at 34weeks was related to maternal leptin in early pregnancy (β=0.16, p=0.02). Both maternal and fetal leptin correlated with infant size at birth (β=0.12, p=0.07 in early pregnancy, β=0.21, p=0.004 in cord blood), independent of all other outcome measures. CONCLUSION Our findings have confirmed that in a non-diabetic cohort there is a link between maternal and fetal leptin and insulin resistance. We also established a link between maternal leptin in early pregnancy and both fetal and neonatal size. These results add to the growing body of evidence suggesting a role for leptin in the fetal programming of childhood obesity and metabolic dysfunction.
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Lindsay KL, Kennelly M, Culliton M, Smith T, Maguire OC, Shanahan F, Brennan L, McAuliffe FM. Probiotics in obese pregnancy do not reduce maternal fasting glucose: a double-blind, placebo-controlled, randomized trial (Probiotics in Pregnancy Study). Am J Clin Nutr 2014; 99:1432-9. [PMID: 24646819 DOI: 10.3945/ajcn.113.079723] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent studies have reported beneficial effects of probiotics on maternal glycemia in healthy pregnant women. Obesity significantly increases risk of impaired glucose tolerance in pregnancy, but glycemic effects of probiotics in this specific obstetric group require additional investigation. OBJECTIVE The aim of the Probiotics in Pregnancy Study was to investigate the effect of a probiotic capsule on maternal fasting glucose in obese pregnant women. DESIGN In this placebo-controlled, double-blind, randomized trial, 175 pregnant women with an early pregnancy body mass index (BMI; in kg/m²) from 30.0 to 39.9 were recruited from antenatal clinics at the National Maternity Hospital, Dublin, Ireland. Exclusion criteria were BMI <30.0 or >39.9, prepregnancy or gestational diabetes, age <18 y, multiple pregnancy, and fetal anomaly. Women were randomly assigned to receive either a daily probiotic or a placebo capsule from 24 to 28 wk of gestation in addition to routine antenatal care. The primary outcome was the change in fasting glucose between groups from preintervention to postintervention. Secondary outcomes were the incidence of gestational diabetes and neonatal anthropometric measures. RESULTS In 138 women who completed the study (63 women in the probiotic group; 75 women in the placebo group), mean (±SD) early pregnancy BMI was 33.6 ± 2.6, which differed significantly between probiotic (32.9 ± 2.4) and placebo (34.1 ± 2.7) groups. With adjustment for BMI, the change in maternal fasting glucose did not differ significantly between treated and control groups [-0.09 ± 0.27 compared with -0.07 ± 0.39 mmol/L; P = 0.391; B = -0.05 (95% CI: -0.17, 0.07)]. There were also no differences in the incidence of impaired glycemia (16% in the probiotic group compared with 15% in the placebo group; P = 0.561), birth weight (3.70 kg in the probiotic group compared with 3.68 kg in the placebo group; P = 0.723), or other metabolic variables or pregnancy outcomes. A secondary analysis of 110 women, excluding antibiotic users and poor compliers, also revealed no differences in maternal glucose or other outcomes between groups. CONCLUSION Probiotic treatment of 4 wk during pregnancy did not influence maternal fasting glucose, the metabolic profile, or pregnancy outcomes in obese women.
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Affiliation(s)
- Karen L Lindsay
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Maria Kennelly
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Marie Culliton
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Thomas Smith
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Orla C Maguire
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Fergus Shanahan
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Lorraine Brennan
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
| | - Fionnuala M McAuliffe
- From the University College Dublin (UCD) Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland (KLL, MK, and FMM); Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (MC); the Department of Clinical Chemistry, St Vincent's University Hospital, Elm Park, Dublin, Ireland (TS and OCM); the Department of Medicine, Alimentary and Pharmabiotic Centre, University College Cork, Cork, Ireland (FS); and the Institute of Food and Health, UCD School of Agriculture and Food Science, UCD, Belfield, Dublin, Ireland (LB)
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Bhat RG, Nathan A, R A, Vasudeva A, Adiga P, Bhat PV, Kumar N P. Correlation of fetal abdominal subcutaneous tissue thickness by ultrasound to predict birth weight. J Clin Diagn Res 2014; 8:OC09-11. [PMID: 24959482 DOI: 10.7860/jcdr/2014/6498.4214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 02/14/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fetal growth abnormality is associated with changes in the soft tissue mass, which is decreased in growth restricted fetuses and increased in macrosomia. OBJECTIVE To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by ultrasound at term and birth weight and to obtain a cut-off value of FASTT to predict large and small for gestational age babies in our population. METHODS FASTT was measured at the anterior 1/3(rd) of abdominal circumference by ultrasound after 36 weeks and weight of the baby measured after birth. RESULTS There was positive correlation between FASTT and birth weight. FASTT of 6.25 mm was sensitive to predict large for gestational age (LGA) babies and had a high negative predictive value; FASTT measurement for prediction of small babies with birth weight < 2500 g was not sensitive. CONCLUSION FASTT can be used as an additional indicator to predict large for gestational age babies along with other known birth weight indicators.
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Affiliation(s)
- Rajeshwari G Bhat
- Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College , Manipal University, Manipal, Karnataka, India
| | - Anitha Nathan
- Private Consultant, Department of Obstetrics and Gynaecology, Motherhood Hospital Banglore, Karnataka, India
| | - Amar R
- Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College , Manipal University, Manipal, Karnataka, India
| | - Akhila Vasudeva
- Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College , Manipal University, Manipal, Karnataka, India
| | - Prashanth Adiga
- Associate Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College , Manipal University, Manipal, Karnataka, India
| | - Parvati V Bhat
- Professor, Department of Obstetrics and Gynaecology, Dr TMA Pai Hospital , Udupi, Manipal University, Manipal, Karnataka, India
| | - Pratap Kumar N
- Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College , Manipal University, Manipal Karnataka, India
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Garabedian C, Vambergue A, Salleron J, Deruelle P. Prediction of macrosomia by serial sonographic measurements of fetal soft-tissues and the liver in women with pregestational diabetes. DIABETES & METABOLISM 2013; 39:511-8. [DOI: 10.1016/j.diabet.2013.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/03/2013] [Accepted: 03/12/2013] [Indexed: 12/27/2022]
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Walsh JM, McGowan CA, Byrne JA, Rath A, McAuliffe FM. The association between TNF-α and insulin resistance in euglycemic women. Cytokine 2013; 64:208-12. [DOI: 10.1016/j.cyto.2013.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/18/2013] [Accepted: 07/02/2013] [Indexed: 11/28/2022]
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Anblagan D, Deshpande R, Jones NW, Costigan C, Bugg G, Raine-Fenning N, Gowland PA, Mansell P. Measurement of fetal fat in utero in normal and diabetic pregnancies using magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:335-340. [PMID: 23288811 DOI: 10.1002/uog.12382] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/27/2012] [Accepted: 12/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To assess the reliability of magnetic resonance imaging (MRI) to measure fetal fat volume in utero, and to study fetal growth in women with and without diabetes in view of the increased prevalence of macrosomia in the former. METHODS We studied 26 pregnant women, 14 with pre-gestational diabetes and 12 non-diabetic controls. Fetal assessment took place at 24 weeks' gestation and again at 34 weeks by standard ultrasound biometry followed by MRI at 1.5 T. Fetal fat volume was determined from T1-weighted water-suppressed images using a semi-automated approach based on pixel intensity and taking into account partial volume effects. Fetal volume was also determined from the MRI images. Fetal weight was calculated using published fat and lean tissue densities. RESULTS There was little fetal fat at 24 weeks' gestation, but at 34 weeks the fetal fat content was considerably higher in the women with diabetes, with a mean fat content of 1090 ± 417 cm(3) compared with 541 ± 348 cm(3) in the controls (P = 0.006). Measurements of fetal fat volume showed low intra- and interobserver variability at 34 weeks, with intraclass correlation coefficients consistently above 0.99. Birth-weight centile correlated with fetal fat volume (R(2) = 0.496, P < 0.001), percentage of fetal fat (R(2) = 0.362, P = 0.008) and calculated fetal weight (R(2) = 0.492, P < 0.001) at 34 weeks. CONCLUSIONS MRI appears to be a promising tool for the determination of fetal fat, body composition and weight in utero during the third trimester of pregnancy.
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Affiliation(s)
- D Anblagan
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, Nottingham, UK
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O'Connor C, Farah N, O'Higgins A, Segurado R, Fitzpatrick C, Turner MJ, Stuart B, Kennelly MM. Longitudinal measurement of fetal thigh soft tissue parameters and its role in the prediction of birth weight. Prenat Diagn 2013; 33:945-51. [PMID: 23716034 DOI: 10.1002/pd.4170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/03/2013] [Accepted: 05/24/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to profile longitudinal changes in thigh muscle and fat with gestation and to determine whether thigh measurements can improve the prediction of birth weight (BW). METHODS A prospective longitudinal study of subcutaneous soft tissue measurements was conducted in 328 singleton fetuses at 28 and 37 weeks gestation. Estimated fetal weight (EFW) was calculated using abdominal circumference, femur length, biparietal diameter, and head circumference. RESULTS The fetal abdominal subcutaneous tissue (FAST) and thigh muscle and fat show an increase with gestation. At 28 weeks gestation, the abdominal circumference, thigh fat, FAST, and EFW percentile were found to be significant predictors of BW. A combination of EFW percentile and thigh fat were found to be the optimal multivariate model at 28 weeks for predicting BW. At 37 weeks, BW prediction using EFW percentile, FAST, and thigh fat was the most accurate. The results revealed acceptable reproducibility for fetal thigh muscle and fat. CONCLUSION This study provides reference ranges for thigh fat and muscle at 28 and 37 weeks gestation. The inclusion of fetal thigh fat in the algorithm improves the predictive power for birth weight. This information is important to explore the role of fetal thigh in the detection of aberrant growth.
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Affiliation(s)
- Clare O'Connor
- Ultrasound and Fetal Medicine Centre, Coombe Women and Infants University Hospital, Dublin, Ireland; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
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Hehir MP, Laursen H, Higgins MF, Brennan DJ, O'Connor DP, McAuliffe FM. Ghrelin concentrations in maternal and cord blood of type 1 diabetic and non-diabetic pregnancies at term. Endocrine 2013; 43:233-5. [PMID: 22740095 DOI: 10.1007/s12020-012-9735-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Mark P Hehir
- UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
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Dowling D, McAuliffe FM. The molecular mechanisms of offspring effects from obese pregnancy. Obes Facts 2013; 6:134-45. [PMID: 23571656 PMCID: PMC5644678 DOI: 10.1159/000350706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/29/2012] [Indexed: 11/19/2022] Open
Abstract
The incidence of obesity, increased weight gain and the popularity of high-fat / high-sugar diets are seriously impacting upon the global population. Billions of individuals are affected, and although diet and lifestyle are of paramount importance to the development of adult obesity, compelling evidence is emerging which suggests that maternal obesity and related disorders may be passed on to the next generation by non-genetic means. The processes acting within the uteri of obese mothers may permanently predispose offspring to a diverse plethora of diseases ranging from obesity and diabetes to psychiatric disorders. This review aims to summarise some of the molecular mechanisms and active processes currently known about maternal obesity and its effect on foetal and neonatal physiology and metabolism. Complex and multifactorial networks of molecules are intertwined and culminate in a pathologically synergistic manner to cause disruption and disorganisation of foetal physiology. This altered phenotype may potentiate the cycle of intergenerational transmission of obesity and related disorders.
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Affiliation(s)
| | - Fionnuala M. McAuliffe
- *Prof. Dr. Fionnuala M. McAuliffe, UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2 (Ireland),
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Higgins MF, Russell NM, Brazil DP, Firth RG, McAuliffe FM. Fetal and maternal leptin in pre-gestational diabetic pregnancy. Int J Gynaecol Obstet 2012. [DOI: 10.1016/j.ijgo.2012.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Walsh JM, McGowan CA, Kilbane M, McKenna MJ, McAuliffe FM. The relationship between maternal and fetal vitamin D, insulin resistance, and fetal growth. Reprod Sci 2012; 20:536-41. [PMID: 22968764 DOI: 10.1177/1933719112459222] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Evidence for a role of vitamin D in maintaining normal glucose homeostasis is inconclusive. We sought to clarify the relationship between maternal and fetal insulin resistance and vitamin D status. This is a prospective cohort study of 60 caucasian pregnant women. Concentrations of 25-hydroxyvitamin D (25-OHD), glucose, insulin, and leptin were measured in early pregnancy and at 28 weeks. Ultrasound at 34 weeks assessed fetal anthropometry including abdominal wall width, a marker of fetal adiposity. At delivery birth weight was recorded and fetal 25-OHD, glucose, C-peptide, and leptin measured in cord blood. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) equation. We found that those with lower 25-OHD in early pregnancy had higher HOMA indices at 28 weeks, (r = -.32, P = .02). No significant relationship existed between maternal or fetal leptin and 25-OHD, or between maternal or fetal 25-OHD and fetal anthropometry or birth weight. The incidence of vitamin D deficiency was high at each time point (15%-45%). These findings lend support to routine antenatal supplementation with vitamin D in at risk populations.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, National Maternity Hospital, University College Dublin, Dublin, Ireland
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40
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Hehir MP, Laursen H, Higgins MF, Brennan DJ, O'Connor DP, McAuliffe FM. Maternal and fetal cocaine- and amphetamine-regulated transcript in diabetic and non-diabetic pregnancy. Gynecol Endocrinol 2012; 28:682-5. [PMID: 22332848 DOI: 10.3109/09513590.2011.652245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cocaine- and amphetamine-regulated transcript (CART) is a leptin-regulated anorectic neuropeptide. Increased levels of leptin in cord blood of diabetic mothers have previously been described. The aim of this study was to quantify maternal and fetal serum CART levels in type 1 diabetes mellitus (T1DM, n = 10) and non-diabetic pregnancy (n = 10). Matched maternal serum samples (n = 20) were obtained at 36-weeks gestation and cord samples from the umbilical vein at delivery (n = 20), CART was quantified using a competitive enzyme immunoassay. Statistical analysis was performed using Spearmans correlation and t test. There was no difference in maternal CART levels at 36-weeks gestation between T1DM (mean = 331.13 pg/ml, Standard Error of the Mean (SEM) = 114.54) and non-diabetic pregnancy (mean = 195.01 pg/ml SEM = 29.37) (p = 0.106). Fetal CART levels in the umbilical vein were similar in T1DM (mean = 199.27 pg/ml, SEM = 39.81) and non-diabetic pregnancy (mean = 149.76 pg/ml, SEM = 26.08) (p = 0.143). Maternal serum CART levels measured at 36-weeks gestation correlated with maternal BMI at booking (Spearmans ρ = 0.332) (p = 0.001) irrespective of diabetes. Serum CART can be detected in both diabetic and non-diabetic human pregnancy and may play an important role in body mass regulation in pregnancy.
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Affiliation(s)
- Mark P Hehir
- UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ 2012; 345:e5605. [PMID: 22936795 PMCID: PMC3431285 DOI: 10.1136/bmj.e5605] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group. DESIGN Randomised controlled trial. SETTING Maternity hospital in Dublin, Ireland. PARTICIPANTS 800 women without diabetes, all in their second pregnancy between January 2007 to January 2011, having previously delivered an infant weighing greater than 4 kg. INTERVENTION Women were randomised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy. MAIN OUTCOMES The primary outcome measure was difference in birth weight. The secondary outcome measure was difference in gestational weight gain. RESULTS No significant difference was seen between the two groups in absolute birth weight, birthweight centile, or ponderal index. Significantly less gestational weight gain occurred in women in the intervention arm (12.2 v 13.7 kg; mean difference -1.3, 95% confidence interval -2.4 to -0.2; P=0.01). The rate of glucose intolerance was also lower in the intervention arm: 21% (67/320) compared with 28% (100/352) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L (P=0.02). CONCLUSION A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age infants in a group at risk of fetal macrosomia. It did, however, have a significant positive effect on gestational weight gain and maternal glucose intolerance. TRIAL REGISTRATION Current Controlled Trials ISRCTN54392969.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Walsh JM, McAuliffe FM. Prediction and prevention of the macrosomic fetus. Eur J Obstet Gynecol Reprod Biol 2012; 162:125-30. [PMID: 22459652 DOI: 10.1016/j.ejogrb.2012.03.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 12/18/2022]
Abstract
Fetal macrosomia is associated with significant maternal and neonatal morbidity. In the long term, infants who are large for gestational age are more likely than other infants to be obese in childhood, adolescence and early adulthood, and are inherently at higher risk of cardiovascular and metabolic complications in adulthood. With over one billion adults in the world now overweight and more than 600 million clinically obese, preventing the vicious cycle effect of fetal macrosomia and childhood obesity is an increasingly pertinent issue. Fetal growth is determined by a complex interplay of various genetic and environmental influences. Consequently the prediction of pregnancies at risk of pathological overgrowth is difficult. Many risk factors for fetal macrosomia, such as maternal obesity and advanced maternal age, are also conversely associated with intrauterine growth restriction. Sonographic detection of fetal macrosomia is notoriously fraught with difficulties, with dozens of formulas for estimated fetal weight proposed but few with sufficient sensitivity to alter clinical practice. This calls into question policies of elective delivery based on projected estimated fetal weight cut-offs alone. More recently the identification of markers of fetal adiposity and maternal serum biomarkers are being investigated to improve the antenatal detection of the large for gestational age fetus. Prevention of fetal macrosomia is entirely dependent upon correct identification of those at risk. Maternal weight, gestational weight gain and glycaemic control are the risk factors for fetal macrosomia that are most amenable to intervention, and have potential maternal health benefits beyond pregnancy and childbirth. The ideal method of optimising maternal weight and glucose homeostasis is yet to be elucidated, though a number of promising advances are recently being reported. In this review we outline the contemporary evidence for the prediction and prevention of fetal macrosomia, which is indeed a contemporary dilemma.
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Affiliation(s)
- Jennifer M Walsh
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Higgins MF, Russell NE, Crossey PA, Nyhan KC, Brazil DP, McAuliffe FM. Maternal and fetal placental growth hormone and IGF axis in type 1 diabetic pregnancy. PLoS One 2012; 7:e29164. [PMID: 22363400 PMCID: PMC3281812 DOI: 10.1371/journal.pone.0029164] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022] Open
Abstract
AIM Placental growth hormone (PGH) is a major growth hormone in pregnancy and acts with Insulin Like Growth Factor I (IGF-I) and Insulin Like Growth Hormone Binding Protein 3 (IGFBP3). The aim of this study was to investigate PGH, IGF-I and IGFBP3 in non-diabetic (ND) compared to Type 1 Diabetic (T1DM) pregnancies. METHODS This is a prospective study. Maternal samples were obtained from 25 ND and 25 T1DM mothers at 36 weeks gestation. Cord blood was obtained after delivery. PGH, IGF-I and IGFBP3 were measured using ELISA. RESULTS There was no difference in delivery type, gender of infants or birth weight between groups. In T1DM, maternal PGH significantly correlated with ultrasound estimated fetal weight (r = 0.4, p = 0.02), birth weight (r = 0.51, p<0.05) and birth weight centile (r = 0.41, p = 0.03) PGH did not correlate with HbA1c. Maternal IGF-I was lower in T1DM (p = 0.03). Maternal and fetal serum IGFBP3 was higher in T1DM. Maternal third trimester T1DM serum had a significant band at 16 kD on western blot, which was not present in ND. CONCLUSION Maternal T1DM PGH correlated with both antenatal fetal weight and birth weight, suggesting a significant role for PGH in growth in diabetic pregnancy. IGFBP3 is significantly increased in maternal and fetal serum in T1DM pregnancies compared to ND controls, which was explained by increased proteolysis in maternal but not fetal serum. These results suggest that the normal PGH-IGF-I-IGFBP3 axis in pregnancy is abnormal in T1DM pregnancies, which are at higher risk of macrosomia.
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Affiliation(s)
- Mary F. Higgins
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Noirin E. Russell
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Paul A. Crossey
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Kristine C. Nyhan
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Derek P. Brazil
- Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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The association of maternal and fetal glucose homeostasis with fetal adiposity and birthweight. Eur J Obstet Gynecol Reprod Biol 2011; 159:338-41. [DOI: 10.1016/j.ejogrb.2011.09.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/16/2011] [Accepted: 09/02/2011] [Indexed: 11/23/2022]
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Stereology of the placenta in type 1 and type 2 diabetes. Placenta 2011; 32:564-9. [DOI: 10.1016/j.placenta.2011.04.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 04/17/2011] [Accepted: 04/21/2011] [Indexed: 11/18/2022]
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Higgins M, McAuliffe FM, Mooney EE. Clinical associations with a placental diagnosis of delayed villous maturation: a retrospective study. Pediatr Dev Pathol 2011; 14:273-9. [PMID: 21329421 DOI: 10.2350/10-07-0872-oa.1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Delayed villous maturation (DVM) is a spectrum of placental disease characterized by decreased tertiary villus formation, reduced vasculosyncytial membrane formation, and, in its more severe forms, increased large bullous villi. In some series it has been associated with an increased risk of stillbirth in the late third trimester, but overall there are few data on its significance. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology. This was a retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit between December 2001 and August 2006. Over a 6-year period, 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. One hundred ninety (6.3%) of these selected cases showed DVM. Fifteen placentas from infants with less than 34 completed weeks of gestation were excluded, leaving 175 for further analysis. When compared with controls matched for gestation and delivering within the same time period (n = 175), DVM was significantly associated with pregestational diabetes (8% vs 2.8%, P < .05; relative risk 2.8 [95% confidence interval 1.03-7.6]), gestational diabetes (8.6% vs 3.4%, P < 0.05; relative risk 2.5 [95% confidence interval 0.99-6.3]), and prenatal or intrapartum intrauterine death (8.6% vs 0%, P < 0.05). Delayed villous maturation is associated with both gestational and pregestational diabetes mellitus and with perinatal death.
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Affiliation(s)
- Mary Higgins
- School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
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47
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Pregnancy in women with Type 1 and Type 2 diabetes in Dublin. Ir J Med Sci 2011; 180:469-73. [DOI: 10.1007/s11845-011-0682-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
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Abstract
Sonography is a fundamental tool in the management of pregnancies affected by maternal diabetes. Purposeful use of ultrasound in each trimester provides an invaluable amount of information about the developing fetus including gestational age and growth patterns, anatomical structure and function, assessment of fetal well-being, and prediction of adverse outcome. There are great ongoing research efforts in this field of prenatal diagnosis and management, yet even more are needed.
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Affiliation(s)
- Jennifer M McNamara
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Plaza, 5th Floor Maternity Building, Campus Box 8064, Saint Louis, MO 63110, USA.
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Are there sex differences in Fetal Abdominal Subcutaneous Tissue (FAST) measurements? Eur J Obstet Gynecol Reprod Biol 2009; 148:118-20. [PMID: 19910101 DOI: 10.1016/j.ejogrb.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/23/2009] [Accepted: 10/06/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine if Fetal Abdominal Subcutaneous Tissue (FAST) measurements using antenatal ultrasound differ between male and female fetuses. STUDY DESIGN Women who had an ultrasound examination for fetal growth between 20 and 40 weeks gestation were studied. Women with diabetes mellitus were excluded. The fetal anterior abdominal subcutaneous tissue was measured on the anterior abdominal wall in millimetres anterior to the margins of the ribs, using magnification at the level of the abdominal circumference. The fetal sex was recorded after delivery. RESULTS A total of 557 fetuses were measured, 290 male and 267 female. The FAST measurements increased with gestational age. The FAST increased at the same rate for both male and female fetuses and at any given week there was no sex difference. CONCLUSIONS The increased fat composition in females reported after birth was not found in abdominal wall subcutaneous fat measurements using ultrasound during pregnancy. Antenatal centile charts for FAST do not need to be based on sex.
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Farah N, Stuart B, Donnelly V, Rafferty G, Turner M. What is the value of ultrasound soft tissue measurements in the prediction of abnormal fetal growth? J OBSTET GYNAECOL 2009; 29:457-63. [DOI: 10.1080/01443610903003209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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