1
|
Ambreen S, Yazdani N, Alvi AS, Qazi MF, Hoodbhoy Z. Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study. BMC Pregnancy Childbirth 2024; 24:214. [PMID: 38519904 PMCID: PMC10958913 DOI: 10.1186/s12884-024-06420-3] [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: 01/10/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Early pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW. METHODS This study is a secondary analysis of an ongoing pregnancy cohort "Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)"in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021-5920-15,518). RESULTS Of 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7). CONCLUSION Maternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.
Collapse
Affiliation(s)
| | - Nida Yazdani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
2
|
Blasi I, Daolio J, Pugni V, Comitini G, Morciano M, Grassi G, Todros T, Gargano G, Aguzzoli L. Correlations between parameters of glycaemic variability and foetal growth, neonatal hypoglycaemia and hyperbilirubinemia in women with gestational diabetes. PLoS One 2023; 18:e0282895. [PMID: 36893129 PMCID: PMC9997917 DOI: 10.1371/journal.pone.0282895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/26/2023] [Indexed: 03/10/2023] Open
Abstract
The diagnosis of gestational diabetes mellitus (GDM) is important to prevent maternal and neonatal complications. This study aimed to investigate the feasibility of parameters of glycaemic variability to predict neonatal complications in women with GDM. A retrospective study was conducted on pregnant women tested positive at the oral glucose tolerance test (OGTT) during 16-18 or 24-28 weeks of gestation. Glycaemic measures were extracted from patients' glucometers and expanded to obtain parameters of glycaemic variability. Data on pregnancy outcomes were obtained from clinical folders. Descriptive group-level analysis was used to assess trends in glycaemic measures and foetal outcomes. Twelve patients were included and analysed, accounting for 111 weeks of observations. The analysis of trends in parameters of glycaemic variability showed spikes of glycaemic mean, high blood glucose index and J-index at 30-31 weeks of gestation for cases with foetal macrosomia, defined as foetal growth >90° percentile, neonatal hypoglycaemia and hyperbilirubinemia. Specific trends in parameters of glycaemic variability observed at third trimester correlate with foetal outcomes. Further research is awaited to provide evidence that monitoring of glycaemic variability trends could be more clinically informative and useful than standard glycaemic checks to manage women with GDM at delivery.
Collapse
Affiliation(s)
- Immacolata Blasi
- Department of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- * E-mail:
| | - Valeria Pugni
- Endocrinology and Metabolism Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Department of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, United Kingdom
- Research Centre for the Analysis of Public Policies (CAPP), University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Grassi
- Department of Endocrinology, Diabetology and Metabolism, Azienda ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Tullia Todros
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giancarlo Gargano
- Department of Neonatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
3
|
Oleszczuk-Modzelewska L, Malinowska-Polubiec A, Romejko-Wolniewicz E, Zawiejska A, Czajkowski K. What is the "cost" of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM. BMC Pregnancy Childbirth 2022; 22:654. [PMID: 35986350 PMCID: PMC9392248 DOI: 10.1186/s12884-022-04980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the "cost" of reducing adverse pregnancy outcomes in patients with GDM. METHODS It was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed. RESULTS Both the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001). CONCLUSIONS No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only "cost" of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.
Collapse
Affiliation(s)
- Luiza Oleszczuk-Modzelewska
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Aneta Malinowska-Polubiec
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland.
| | - Ewa Romejko-Wolniewicz
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Agnieszka Zawiejska
- Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, 41 Jackowskiego St, 60-512, Poznan, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| |
Collapse
|
4
|
Marley AR, Domingues A, Ghosh T, Turcotte LM, Spector LG. Maternal BMI, Diabetes, and Gestational Weight Gain and Risk for Pediatric Cancer in Offspring: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2022; 6:6537542. [PMID: 35603850 PMCID: PMC8982388 DOI: 10.1093/jncics/pkac020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pediatric cancer incidence has steadily increased concurrent with rising adult obesity, but associations between maternal obesity and associated comorbidities and pediatric cancer risk remain understudied. We aimed to quantitatively characterize associations of pediatric cancer risk with maternal prepregnancy body mass index (BMI), gestational weight gain, and maternal diabetes. Methods We performed a comprehensive and systematic literature search in Ovid and EMBASE from their inception to March 15, 2021. Eligible studies reported risk estimates and sample sizes and provided sufficient description of outcome and exposure ascertainment. Random effects models were used to estimate pooled effects. Results Thirty-four studies were included in the analysis. Prepregnancy BMI was positively associated with leukemia risk in offspring (odds ratio [OR] per 5-unit BMI increase =1.07, 95% confidence intervals [CI] = 1.04 to 1.11; I2 = 0.0%). Any maternal diabetes was positively associated with acute lymphoblastic leukemia risk (OR = 1.46, 95% CI = 1.28 to 1.67; I2 = 0.0%), even after restricting to birthweight-adjusted analyses (OR = 1.74, 95% CI = 1.29 to 2.34; I2 = 0.0%), and inversely associated with risk of central nervous system tumors (OR = 0.73, 95% CI = 0.55 to 0.97; I2 = 0.0%). Pregestational diabetes (OR = 1.57, 95% CI = 1.11 to 2.24; I2 = 26.8%) and gestational diabetes (OR = 1.40, 95% CI = 1.12 to 1.75; I2 = 0.0%) were also positively associated with acute lymphoblastic leukemia risk. No statistically significant associations were observed for gestational weight gain. Conclusions Maternal obesity and diabetes may be etiologically linked to pediatric cancer, particularly leukemia and central nervous system tumors. Our findings support weight management and glycemic control as important components of maternal and offspring health. Further validation is warranted.
Collapse
Affiliation(s)
- Andrew R Marley
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Allison Domingues
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Taumoha Ghosh
- Division of Hematology/Oncology, Department of Pediatrics, University of Miami, Miami, FL, USA
| | - Lucie M Turcotte
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Logan G Spector
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
Relation of maternal birthweight with early pregnancy obesity, gestational diabetes, and offspring macrosomia. J Dev Orig Health Dis 2022; 13:650-655. [PMID: 35000649 DOI: 10.1017/s2040174421000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate how maternal birthweight is related to early pregnancy obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Females born term and singleton in Sweden between 1973 and 1995 (N = 305,893) were studied at their first pregnancy. Information regarding their birthweight, early pregnancy body mass index, and pregnancy complications was retrieved from the Swedish Medical Birth Register, as were data on their mothers and offspring. High maternal birthweights (2-3 standard deviation scores (SDS) and >3 SDS) were associated with greater odds of early pregnancy obesity, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.42-1.63) and OR 2.06 (CI 1.71-2.49), respectively. A low maternal birthweight (<2 SDS) was associated with greater odds of GDM (OR 2.49, CI 2.00-3.12). No association was found between high maternal birthweight and GDM. A maternal birthweight 2-3 SDS was associated with offspring birthweight 2-3 SDS (OR 3.83, CI 3.44-4.26), and >3 SDS (OR 3.55, CI 2.54-4.97). Corresponding ORs for a maternal birthweight >3 SDS were 5.38 (CI 4.12-7.01) and 6.98 (CI 3.57-13.65), respectively. In conclusion, a high maternal birthweight was positively associated with early pregnancy obesity and offspring macrosomia. A low, but not a high maternal birthweight, was associated with GDM.
Collapse
|
6
|
Sun Y, Zhang M, Liu R, Wang J, Yang K, Wu Q, Yue W, Yin C. Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:805636. [PMID: 35222271 PMCID: PMC8866317 DOI: 10.3389/fendo.2022.805636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/05/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We aimed to assess whether maternal first-trimester low body mass index (BMI) has a protective effect against macrosomia. METHODS This was a cross-sectional study from January 1, 2011, to June 30, 2021, and 84,900 participants were included. The predictive performance of maternal first-trimester and parental pre-pregnancy BMI for macrosomia was assessed using the area under the receiver-operating characteristics curve (AUC). Multivariate logistic regression analyses were performed to evaluate the independent effect of maternal first-trimester low BMI on macrosomia. Interactions were investigated to evaluate the potential variation of the effect of first-trimester low BMI across different groups. Furthermore, interactions were also examined across groups determined by multiple factors jointly: a) gestational diabetes mellitus (GDM)/GDM history status, parity, and maternal age; and b) GDM/GDM history status, fetal sex, and season of delivery. RESULTS The proportion of macrosomia was 6.14% (5,215 of 84,900). Maternal first-trimester BMI showed the best discrimination of macrosomia (all Delong tests: P < 0.001). The protective effect of maternal first-trimester low BMI against macrosomia remained significant after adjusting for all confounders of this study [adjusted odds ratios (aOR) = 0.37, 95% CI: 0.32-0.43]. Maternal first-trimester low BMI was inversely associated with macrosomia, irrespective of parity, fetal sex, season of delivery, maternal age, and GDM/GDM history status. The protective effect was most pronounced among pregnant women without GDM/GDM history aged 25 to 29 years old, irrespective of parity (multipara: aOR = 0.32, 95% CI: 0.22-0.47; nullipara: aOR = 0.32, 95% CI: 0.24-0.43). In multipara with GDM/GDM history, the protective effect of low BMI was only observed in the 30- to 34-year-old group (aOR = 0.12, 95% CI: 0.02-0.86). For pregnant women without GDM/GDM history, the protective effect of maternal first-trimester low BMI against macrosomia was the weakest in infants born in winter, irrespective of fetal sex (female: aOR = 0.45, 95% CI: 0.29-0.69; male: aOR = 0.39, 95% CI: 0.28-0.55). CONCLUSION Maternal first-trimester low BMI was inversely associated with macrosomia, and the protective effect was most pronounced among 25- to 29-year-old pregnant women without GDM/GDM history and was only found among 30- to 34-year-old multipara with GDM/GDM history. The protective effect of maternal first-trimester low BMI against macrosomia was the weakest in winter among mothers without GDM/GDM history.
Collapse
Affiliation(s)
- Yongqing Sun
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Man Zhang
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ruixia Liu
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jingjing Wang
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Qingqing Wu
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- *Correspondence: Chenghong Yin, ; Wentao Yue, ; Qingqing Wu,
| | - Wentao Yue
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- *Correspondence: Chenghong Yin, ; Wentao Yue, ; Qingqing Wu,
| | - Chenghong Yin
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- *Correspondence: Chenghong Yin, ; Wentao Yue, ; Qingqing Wu,
| |
Collapse
|
7
|
Does Repeated Painful Stimuli Change Cerebral Near-Infrared Spectroscopy Response in Healthy, Term, Large for Gestational Age Newborns? Clin J Pain 2021; 36:110-116. [PMID: 31651426 DOI: 10.1097/ajp.0000000000000774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of repeated painful stimuli on short-term pain response in healthy, term, large for gestational age newborns by measuring the regional cerebral oxygen saturation (rScO2), and behavioral and physiological responses. METHODS We compared term large for gestational age infants who received repeated painful stimuli (study group) with term, appropriate for gestational age infants (control group). A pulse oximeter and a near-infrared spectroscopy probe were connected to babies during the study period, and the responses of the babies were recorded by video, from which the crying time and the Neonatal Infant Pain Scale were obtained. The heart rate, peripheral oxygen saturation (SpO2), and rScO2 data were sampled every 1 second and exported to a personal computer via digital output during the study period. The maximum heart rate, the minimum SpO2, and peak, baseline, and mean rScO2 measurements following skin puncture were recorded. Data were compared within 1 group and between the 2 groups. RESULTS After the heel prick, crying time (P<0.001) and Neonatal Infant Pain Scale scores (P=0.024) increased, and SpO2 levels decreased significantly (P=0.012) in the study group versus the control group. Although mean rScO2 increased significantly within 1 group (P<0.001), it was not significant between the 2 groups. The percent change in rScO2 was greater in the study group (5.2 [2.5 to 9.3]) compared with the control group (2.8 [1.1 to 8.2], P=0.037). CONCLUSION We showed that rScO2 values changed significantly within the first few days of life in babies who received more painful stimuli compared with the control group, similar to behavioral and physiological responses.
Collapse
|
8
|
Chee C, Hibbert EJ, Lam P, Nanan R, Liu A. Sonographic and other nonglycemic factors can predict large-for-gestational-age infants in diet-managed gestational diabetes mellitus: A retrospective cohort study. J Diabetes 2020; 12:562-572. [PMID: 32250016 DOI: 10.1111/1753-0407.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/01/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Left untreated or poorly controlled, GDM results in adverse infant outcomes such as large for gestational age (LGA). This study aims to identify nonglycemic maternal and fetal factors predictive of LGA outcomes in pregnancies complicated by diet-managed GDM. METHODS This was a retrospective cohort study of singleton pregnancies complicated by diet-managed GDM from 2004 to 2015. Multiple logistic regression analysis was performed on maternal and perinatal factors to identify risk factors for LGA. In addition, a subset univariate analysis was conducted for pregnancies in which fetal ultrasound abdominal circumference measurements were available at gestational weeks 18 to 22, 24 to 28, and 29 to 33. RESULTS A total of 1064 women were included, delivering 123 LGA infants. Women with higher parity (odds ratio [OR] 1.44; CI, 1.23-1.68; P < .001) and higher prepregnancy body mass index (BMI) (OR 1.09; CI, 1.06-1.12; P < .001) were more likely to have LGA infants. Maternal smoking (OR 0.30; CI, 0.14-0.62; P = .001) and higher gestational age at birth (OR 0.91; CI, 0.84-0.99; P = .018) were associated with reduced risk. Subset univariate analysis showed that fetal abdominal circumference measurements at weeks 24 to 28 and 29 to 33 beyond the 75th percentile (OR 5.92 and 13.74, respectively) and 90th percentile (OR 4.57 and 15.89, respectively) were highly predictive of LGA. CONCLUSIONS Parity, smoking status, maternal BMI, gestational age, and ultrasound fetal abdominal circumference measurements were identified as useful predictors of LGA. Presence of these predictors may prompt closer monitoring of pregnancy and early therapeutic intervention to improve management and reduce the risk of adverse fetal and maternal outcomes.
Collapse
Affiliation(s)
- Chermaine Chee
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
| | - Emily Jane Hibbert
- Department of Endocrinology and Diabetes, Division of Medicine, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
| | - Penny Lam
- Department of Perinatal Ultrasound, Nepean Hospital, Penrith, New South Wales, Australia
| | - Ralph Nanan
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
- Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
| | - Anthony Liu
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia
- Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
| |
Collapse
|
9
|
García-Patterson A, Ovejero D, Miñambres I, Chico A, Gil PA, Martínez MJ, Adelantado JM, de Leiva A, Gich I, Desoye G, de Mouzon SH, Corcoy R. Both glycaemic control and insulin dose during pregnancy in women with type 1 diabetes are associated with neonatal anthropometric measures and placental weight. Diabetes Metab Res Rev 2020; 36:e3300. [PMID: 32048800 DOI: 10.1002/dmrr.3300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 01/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate longitudinal associations of maternal glucose/HbA1c and insulin dose with birthweight-related outcomes in women with type 1 diabetes. METHODS We performed a cohort study including 473 pregnant women with type 1 diabetes with singleton pregnancies. We investigated maternal self-monitored blood glucose (SMBG, mmol/L), HbA1c (%, mmol/mol) and insulin dose (IU/kg/day) in the three trimesters as potential independent variables, while adjusting for potential confounders. Outcomes of interest were birthweight, birthweight SD score, neonatal length, weight/length index, ponderal index and placental weight. Multiple linear regression analysis was performed with separate analyses for SMBG and HbA1c . RESULTS Maternal glucose and insulin dose were independently associated with birthweight-related outcomes. In the main analysis, in the first trimester most associations were positive for insulin dose, in the second the associations were positive for glucose and inverse for insulin while in the third there were no associations. Most sensitivity analyses produced consistent results. In a sensitivity analysis splitting the first trimester in two periods, positive associations of maternal insulin with birthweight-related outcomes were observed in weeks 0+ to 6+. CONCLUSIONS Early in pregnancy in women with type 1 diabetes, maternal insulin dose is positively associated with birthweight-related outcomes, whereas in the second trimester, a positive association with SMBG emerges and the association with maternal insulin becomes inverse. If confirmed in other cohorts, these results would have implications in the management of women with type 1 diabetes.
Collapse
Affiliation(s)
| | - Diana Ovejero
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Inka Miñambres
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Chico
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Alejandro Gil
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María-José Martínez
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan María Adelantado
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Leiva
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Gich
- Department of Clinic Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | | | - Rosa Corcoy
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
10
|
Lorusso L, Kato DMP, Dalla Costa NRA, Araujo Júnior E, Bruns RF. Performance of local reference curve on the diagnosis of large for gestational age fetuses in diabetic pregnant women. J Matern Fetal Neonatal Med 2020; 35:1899-1906. [PMID: 32495678 DOI: 10.1080/14767058.2020.1774539] [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: 10/24/2022]
Abstract
Objective: To evaluate the performance of a local fetal weight curve based on the prediction for large gestational age (LGA) newborns in diabetic pregnant women and to compare it to reference curves established for other populations.Method: A reference model for estimated fetal weight was created from a local sample of 2211 singleton low-risk pregnancies. The estimated fetal weight from 194 women with gestational diabetes mellitus was then plotted on this curve, and the results were compared to those obtained by Intergrowth 21st and Hadlock curves.Results: The sensitivity of the proposed model to predict LGA fetuses was 55.6%, the specificity was 82.1%, and the accuracy was 74.7%. The sensitivity, specificity, and accuracy for the Intergrowth 21st curve were 46.3%, 87.9%, and 76.3%, respectively, and no statistically significant difference was observed compared to the proposed model. Conversely, significant differences were observed for the Hadlock curve, which presented a lower sensitivity (24.1%), higher specificity (97.1%), and similar accuracy (76.8%).Conclusion: The sensitivity of the proposed model was higher compared to the Hadlock curve for the screening of LGA newborns in diabetic pregnant women. However, no significant differences were observed in comparison to the Intergrowth 21st curve.
Collapse
Affiliation(s)
- Liziane Lorusso
- Department of Gynecology and Obstetrics, Federal University of Paraná (UFPR), Curitiba-PR, Brazil
| | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.,Medical Course, Bela Vista Campus, Municipal University of São Caetano do Sul (USCS), São Paulo-SP, Brazil
| | - Rafael Frederico Bruns
- Department of Gynecology and Obstetrics, Federal University of Paraná (UFPR), Curitiba-PR, Brazil
| |
Collapse
|
11
|
Chu AHY, Tint MT, Chang HF, Wong G, Yuan WL, Tull D, Nijagal B, Narayana VK, Meikle PJ, Chang KTE, Lewis RM, Chi C, Yap FKP, Tan KH, Shek LP, Chong YS, Gluckman PD, Lee YS, Fortier MV, Godfrey KM, Eriksson JG, Karnani N, Chan SY. High placental inositol content associated with suppressed pro-adipogenic effects of maternal glycaemia in offspring: the GUSTO cohort. Int J Obes (Lond) 2020; 45:247-257. [PMID: 32433604 PMCID: PMC7752752 DOI: 10.1038/s41366-020-0596-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
Background/Objectives Maternal glycaemia promotes fetal adiposity. Inositol, an insulin sensitizer, has been trialled for gestational diabetes prevention. The placenta has been implicated in how maternal hyperglycaemia generates fetal pathophysiology, but no studies have examined whether placental inositol biology is altered with maternal hyperglycaemia, nor whether such alterations impact fetal physiology. We aimed to investigate whether the effects of maternal glycaemia on offspring birthweight and adiposity at birth differed across placental inositol levels. Methods Using longitudinal data from the Growing Up in Singapore Towards healthy Outcomes cohort, maternal fasting glucose (FPG) and 2-hour plasma glucose (2hPG) were obtained in pregnant women by a 75-g oral glucose tolerance test around 26 weeks’ gestation. Relative placental inositol was quantified by liquid chromatography-mass spectrometry. Primary outcomes were birthweight (n = 884) and abdominal adipose tissue (AAT) volumes measured by neonatal MRI scanning in a subset (n = 262) of term singleton pregnancies. Multiple linear regression analyses were performed. Results Placental inositol was lower in those with higher 2hPG, no exposure to tobacco smoke antenatally, with vaginal delivery and shorter gestation. Positive associations of FPG with birthweight (adjusted β [95% CI] 164.8 g [109.1, 220.5]) and AAT (17.3 ml [11.9, 22.6] per mmol glucose) were observed, with significant interactions between inositol tertiles and FPG in relation to these outcomes (p < 0.05). Stratification by inositol tertiles showed that each mmol/L increase in FPG was associated with increased birthweight and AAT volume among cases within the lowest (birthweight = 174.2 g [81.2, 267.2], AAT = 21.0 ml [13.1, 28.8]) and middle inositol tertiles (birthweight = 202.0 g [103.8, 300.1], AAT = 19.7 ml [9.7, 29.7]). However, no significant association was found among cases within the highest tertile (birthweight = 81.0 g [−21.2, 183.2], AAT = 0.8 ml [−8.4, 10.0]). Conclusions High placental inositol may protect the fetus from the pro-adipogenic effects of maternal glycaemia. Studies are warranted to investigate whether prenatal inositol supplementation can increase placental inositol and reduce fetal adiposity.
Collapse
Affiliation(s)
- Anne H Y Chu
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mya T Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Hsin F Chang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Gerard Wong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dedreia Tull
- Metabolomics Australia, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, VIC, Australia
| | - Brunda Nijagal
- Metabolomics Australia, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, VIC, Australia
| | - Vinod K Narayana
- Metabolomics Australia, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, VIC, Australia
| | - Peter J Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's & Children's Hospital, Singapore, Singapore
| | - Rohan M Lewis
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claudia Chi
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Fabian K P Yap
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lynette P Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Folkhalsan Research Center, Helsinki, Finland
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore. .,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
| |
Collapse
|
12
|
Bedu-Addo K, Ephraim RK, Tanoe-Blay C, Ahenkorah-Fondjo L, Osei-Darkwah K, Ephraim M, Kontoh KA, Abaka-Yawson A. Prevalence and associated factors of fetal macrosomia in a rural community in Ghana. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1746602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kweku Bedu-Addo
- Department of Physiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology Ghana
| | - Richard K.D. Ephraim
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast Ghana
| | - Comfort Tanoe-Blay
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast Ghana
| | - Linda Ahenkorah-Fondjo
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology Ghana
| | - Kwame Osei-Darkwah
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast Ghana
| | - Mabel Ephraim
- Kumasi Nursing and Midwifery Training School Kumasi Ghana
| | | | - Albert Abaka-Yawson
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Sciences Ho Ghana
| |
Collapse
|
13
|
Tang J, Zhu X, Li M, Huang D, Zhao Q. The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age: a large population-based cohort study. Am J Obstet Gynecol 2020; 222:265.e1-265.e19. [PMID: 31574291 DOI: 10.1016/j.ajog.2019.09.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age has been poorly understood. OBJECTIVES We aimed to estimate the impact of prepregnancy impaired fasting glucose defined by the World Health Organization cut point on the risk of preterm birth and large for gestational age and to investigate whether the World Health Organization cut point of impaired fasting glucose was appropriate for identifying women at risk of preterm birth and large for gestational age among the Chinese population. STUDY DESIGN This was a retrospective cohort study of women from the National Free Preconception Health Examination Project with singleton birth from 121 counties/districts in 21 cities of Guangdong Province, China, from Jan. 1, 2013, to Dec. 31, 2017. Women were included if their prepregnancy fasting glucose was less than 7.0 mmol/L. The primary outcomes were preterm birth (gestational age <37 weeks), early preterm birth (gestational age <34 weeks), large for gestational age (birthweight by gestational age >90th percentile based on the international standards in the International Fetal and Newborn Growth Consortium for the 21st Century study), and severe large for gestational age (birthweight by gestational age >97th percentile). We calculated the adjusted risk ratio for impaired fasting glucose and a 1 standard deviation increase in fasting glucose. RESULTS We included 640,469 women. Of these, 31,006 (4.84%) met the World Health Organization cut point for impaired fasting glucose, 32,640 (5.10%) had preterm birth and 7201 (1.12%) had early preterm birth, 45,532 (7.11%) had large for gestational age birth, and 16,231 (2.53%) had severe large for gestational age birth. Compared with women with normoglycaemia, women with prepregnancy impaired fasting glucose had a 7.0% higher risk of preterm birth (adjusted risk ratio, 1.07, 95% confidence interval, 1.02-1.12), 10.0% had a higher risk of large for gestational age (adjusted risk ratio, 1.10, 95% confidence interval, 1.06-1.14), and 17.0% had a higher risk of severe large for gestational age (adjusted risk ratio, 1.17, 95% confidence interval, 1.10-1.26). No significant association of prepregnancy impaired fasting glucose with early preterm birth was found. The association of prepregnancy impaired fasting glucose with preterm birth and large for gestational age were similar in subgroups of women with various baseline characteristics. Adjusted risk ratio for preterm birth per standard deviation fasting glucose (0.7 mmol/L) was 0.99 (95% confidence interval, 0.98-1.00), for early preterm birth an adjusted risk ratio of 0.99 (confidence interval, 0.97-1.02), for large for gestational age an adjusted risk ratio of 1.04 (confidence interval, 1.03-1.05), and for severe large for gestational age an adjusted risk ratio of 1.03 (confidence interval, 1.01-1.04). CONCLUSION Our data suggest that maternal prepregnancy impaired fasting glucose increases the risk of preterm birth, large for gestational age, and severe large for gestational age. Data also suggest that the World Health Organization cut point of impaired fasting glucose is too restrictive, and lower levels of fasting glucose also increase the risk of large for gestational age and severe for severe gestational age in the Chinese population. Further investigation is warranted to determine whether and how counseling and interventions for women with prepregnancy impaired fasting glucose could reduce the risk of preterm birth and large for gestational age.
Collapse
Affiliation(s)
- Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University; First Affiliated Hospital of Guangzhou Medical University; Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom.
| | | | - Mingzhen Li
- Guangdong Institute of Family Planning Science and Technology; Family Planning Special Hospital of Guangdong
| | - Dongming Huang
- Guangdong Institute of Family Planning Science and Technology; Family Planning Special Hospital of Guangdong
| | - Qingguo Zhao
- Guangdong Institute of Family Planning Science and Technology; Family Planning Special Hospital of Guangdong; National Health Committee of China (NHCC), Key Laboratory of Male Reproduction and Genetics.
| |
Collapse
|
14
|
Nouhjah S, Shahbazian H, Latifi SM, Malamiri RA, Ghodrati N. Body mass index growth trajectories from birth through 24 months in Iranian infants of mothers with gestational diabetes mellitus. Diabetes Metab Syndr 2019; 13:408-412. [PMID: 30641734 DOI: 10.1016/j.dsx.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/09/2018] [Indexed: 12/30/2022]
Abstract
AIMS Child growth is one of the important health indicators in pediatric care. Few studies focused on the impact of prenatal exposure to gestational diabetes mellitus (GDM) on growth trajectories particular in early years of childhood. The aim of this study was identifying growth pattern of GDM exposed offspring's, comparison with new WHO child growth standards. METHODS AND MATERIALS In a population-based Longitudinal study 438 infants exposed to gestational diabetes in utero, aged 0-24 months, born between 2014 and 2016 with at least 9 visits in first 2 years of life were enrolled. Twenty health centers of Ahvaz city (Capital of Khuzestan province, located in south western of Iran) and two referral centers for neonatal hypothyroidism involved the study. RESULTS Of 438 GDM exposed infants, 54.6% were boys. Incidence of low birth weight and macrosomia were 4.6% and 8.7% respectively. RESULTS 4.6% had birth weight less than 2500gr and 8.7% was rate of macrosomia. Boys had higher weight and BMI than girls. Peak of BMI was 17.8 (±2.07) at 6 months after Gender was significant factor in predicted of BMI growth trajectories in GDM exposed children (p = 0.001). BMI in GDM exposed infants, in first 2 years of life was higher than WHO growth standards 2006 (P < 0.01). CONCLUSION Medians of BMI in GDM exposed infants in all measures was higher than WHO reference data 2006 (P < 0.01). Obesity prevention programs must be priority in GDM exposed infants.
Collapse
Affiliation(s)
- Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mahmoud Latifi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Azizi Malamiri
- Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Niloofar Ghodrati
- Student Research Committee, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
15
|
Yang Y, Wang Z, Mo M, Muyiduli X, Wang S, Li M, Jiang S, Wu Y, Shao B, Shen Y, Yu Y. The association of gestational diabetes mellitus with fetal birth weight. J Diabetes Complications 2018; 32:635-642. [PMID: 29907325 DOI: 10.1016/j.jdiacomp.2018.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/24/2018] [Accepted: 04/18/2018] [Indexed: 01/23/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) and different time-point glucose levels might have different effects on fetal birth weight. The aim of this study was to further evaluate the associations of GDM and different time-point blood glucose levels with fetal birth weight in a prospective cohort study. METHODS This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to May 2015. 1232 pairs of singleton, full-term newborns and their mothers without other pregnant and perinatal complications were selected as participants. RESULTS Of the 1232 women, 234 had GDM. GDM was positively associated with birth weight (β = 99.5 g, P = 0.0002), gestational age-specific Z-score of birth weight (β = 0.23, P = 0.0003), and an increased risk of large for gestational age (LGA; OR = 1.79, 95%CI: 1.11-2.89) and macrosomia (OR = 2.13, 95%CI: 1.34-3.40). Compared with abnormal fasting plasma glucose (FPG) during the second trimester, abnormal postload glucose in oral glucose tolerance test had significantly higher birth weight and gestational age-specific Z-score of birth weight, and an increased risk of macrosomia. Abnormal FPG and abnormal postload glucose had significantly joint effect on birth weight (β = 161.4 g, P = 0.0192), gestational age-specific Z-score of birth weight (β = 0.42, P = 0.0121) and risk of macrosomia (OR = 3.24, 95%CI: 1.21-8.67) and LGA (OR = 5.73, 95%CI: 2.20-14.90). Compared with abnormal blood glucose during the first trimester, GDM had significantly higher birth weight and gestational age-specific Z-score of birth weight. Abnormal blood glucose during the first trimester and GDM had significantly joint effect on birth weight (β = 125.8 g, P = 0.0010), gestational age-specific Z-score of birth weight (β = 0.30, P = 0.0013) and risk of macrosomia (OR = 2.34, 95%CI: 1.28-4.30) and LGA (OR = 2.53, 95%CI: 1.37-4.67). However, we did not find blood glucose during the first trimester independently associated with birth weight. CONCLUSIONS GDM was significantly associated with higher birth weight and an increased risk of LGA and macrosomia. Fetal growth was mostly influenced by postload glucose levels, rather than FBG. Moreover, different time-point blood glucose levels had significantly joint effects on birth weight and risk of LGA and macrosomia.
Collapse
Affiliation(s)
- Yi Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhaopin Wang
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China; Office of Graduate Education, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Minjia Mo
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Xiamusiye Muyiduli
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Shuojia Wang
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Minchao Li
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Shuying Jiang
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Yimin Wu
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Bule Shao
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Yu Shen
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Yunxian Yu
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, Zhejiang, China.
| |
Collapse
|
16
|
Liu Y, Hou W, Meng X, Zhao W, Pan J, Tang J, Huang Y, Li H, Tao M, Liu F. Early elevated alkaline phosphatase increases the risk of large-for-gestational-age birth weight in pregnant women with normal glucose tolerance. Diabetes Res Clin Pract 2018; 141:209-216. [PMID: 29730386 DOI: 10.1016/j.diabres.2018.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/30/2018] [Accepted: 04/12/2018] [Indexed: 02/03/2023]
Abstract
AIMS The aim of this study was to assess the association between levels of alkaline phosphatase (ALP) in early pregnancy and the incidence of large-for-gestational-age (LGA) neonates in pregnant women without gestational diabetes mellitus. METHODS A prospective cohort was carried out in 544 women and their biochemical parameters including serum ALP and demographic characteristics were collected in 13-16th gestational week. At 24-28th weeks of gestation, 50 g oral glucose challenge test and oral 75 g glucose tolerance test was performed. LGA was defined as birth weight ≥ 90th percentile for completed week of gestational age based on the sex-specific growth curves. Logistic regression and receiver operating characteristic analysis were utilized to identify independent risk factors and odds ratio among ALP quartiles for incidence of LGA. RESULTS Women diagnosed as LGA held higher level of ALP than women in non-LGA group (P = 0.008). Moreover, ALP (odds ratio (OR) 1.05 [95% confidence interval (CI): 1.00, 1.10]) was the independent risk factors associated with LGA. Compared with ALP quartile 1, women in quartile 4 had more than 2.5-fold increased odds of LGA (OR 3.78, 95% CI: 1.10, 13.02), and the risk reached 4 times after adjusting several covariates (OR 4.15, 95% CI: 1.14,15.13). CONCLUSIONS A significantly increased risk of LGA was associated with higher serum concentrations of ALP in pregnant women with NGT, even it is in normal reference range.
Collapse
Affiliation(s)
- Yingfeng Liu
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Wolin Hou
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Xiyan Meng
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijing Zhao
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jiemin Pan
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Junling Tang
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Yajuan Huang
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huaping Li
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Minfang Tao
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Liu
- Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
| |
Collapse
|
17
|
Farrar D, Simmonds M, Griffin S, Duarte A, Lawlor DA, Sculpher M, Fairley L, Golder S, Tuffnell D, Bland M, Dunne F, Whitelaw D, Wright J, Sheldon TA. The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation. Health Technol Assess 2018; 20:1-348. [PMID: 27917777 DOI: 10.3310/hta20860] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a higher risk of important adverse outcomes. Practice varies and the best strategy for identifying and treating GDM is unclear. AIM To estimate the clinical effectiveness and cost-effectiveness of strategies for identifying and treating women with GDM. METHODS We analysed individual participant data (IPD) from birth cohorts and conducted systematic reviews to estimate the association of maternal glucose levels with adverse perinatal outcomes; GDM prevalence; maternal characteristics/risk factors for GDM; and the effectiveness and costs of treatments. The cost-effectiveness of various strategies was estimated using a decision tree model, along with a value of information analysis to assess where future research might be worthwhile. Detailed systematic searches of MEDLINE® and MEDLINE In-Process & Other Non-Indexed Citations®, EMBASE, Cumulative Index to Nursing and Allied Health Literature Plus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database, Maternity and Infant Care database and the Cochrane Methodology Register were undertaken from inception up to October 2014. RESULTS We identified 58 studies examining maternal glucose levels and outcome associations. Analyses using IPD alone and the systematic review demonstrated continuous linear associations of fasting and post-load glucose levels with adverse perinatal outcomes, with no clear threshold below which there is no increased risk. Using IPD, we estimated glucose thresholds to identify infants at high risk of being born large for gestational age or with high adiposity; for South Asian (SA) women these thresholds were fasting and post-load glucose levels of 5.2 mmol/l and 7.2 mmol/l, respectively and for white British (WB) women they were 5.4 and 7.5 mmol/l, respectively. Prevalence using IPD and published data varied from 1.2% to 24.2% (depending on criteria and population) and was consistently two to three times higher in SA women than in WB women. Lowering thresholds to identify GDM, particularly in women of SA origin, identifies more women at risk, but increases costs. Maternal characteristics did not accurately identify women with GDM; there was limited evidence that in some populations risk factors may be useful for identifying low-risk women. Dietary modification additional to routine care reduced the risk of most adverse perinatal outcomes. Metformin (Glucophage,® Teva UK Ltd, Eastbourne, UK) and insulin were more effective than glibenclamide (Aurobindo Pharma - Milpharm Ltd, South Ruislip, Middlesex, UK). For all strategies to identify and treat GDM, the costs exceeded the health benefits. A policy of no screening/testing or treatment offered the maximum expected net monetary benefit (NMB) of £1184 at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY). The NMB for the three best-performing strategies in each category (screen only, then treat; screen, test, then treat; and test all, then treat) ranged between -£1197 and -£1210. Further research to reduce uncertainty around potential longer-term benefits for the mothers and offspring, find ways of improving the accuracy of identifying women with GDM, and reduce costs of identification and treatment would be worthwhile. LIMITATIONS We did not have access to IPD from populations in the UK outside of England. Few observational studies reported longer-term associations, and treatment trials have generally reported only perinatal outcomes. CONCLUSIONS Using the national standard cost-effectiveness threshold of £20,000 per QALY it is not cost-effective to routinely identify pregnant women for treatment of hyperglycaemia. Further research to provide evidence on longer-term outcomes, and more cost-effective ways to detect and treat GDM, would be valuable. STUDY REGISTRATION This study is registered as PROSPERO CRD42013004608. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK.,Department of Health Sciences, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Lesley Fairley
- Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, UK
| | - Derek Tuffnell
- Bradford Women's and Newborn Unit, Bradford Teaching Hospitals, Bradford, UK
| | - Martin Bland
- Department of Health Sciences, University of York, York, UK
| | - Fidelma Dunne
- Galway Diabetes Research Centre (GDRC) and School of Medicine, National University of Ireland, Galway, Republic of Ireland
| | - Donald Whitelaw
- Department of Diabetes & Endocrinology, Bradford Teaching Hospitals, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK
| | | |
Collapse
|
18
|
Tänczer T, Magenheim R, Fürst Á, Domján B, Janicsek Z, Szabó E, Ferencz V, Tabák ÁG. The Relationship between 25-hydroxyvitamin D Levels, Insulin Sensitivity and Insulin Secretion in Women 3 Years after Delivery. Can J Diabetes 2017; 41:621-627. [DOI: 10.1016/j.jcjd.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
|
19
|
Al Omran BS, Al Ammari FH, Dayoub NM. Pregnancy outcomes in relation to different types of diabetes mellitus and modes of delivery in macrosomic foetuses in Bahrain. J Taibah Univ Med Sci 2017; 12:55-59. [PMID: 31435213 PMCID: PMC6695014 DOI: 10.1016/j.jtumed.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 11/28/2022] Open
Abstract
Objectives The mode of delivery in diabetic patients is debatable. This study was designed to assess the pattern of delivery of macrosomic babies with a high prevalence of diabetes mellitus in Bahrain. Methods This retrospective analysis was conducted on mothers who delivered babies weighing ≥4.0 Kgs from 2001 to 2011 at Bahrain Defence Force Hospital. Data regarding patients' age, weight, mode of delivery, diabetic status, gestational age and parity were recorded. The main outcome was the effect of diabetes mellitus on the decision to allow vaginal delivery for macrocosmic babies. Other outcomes were failed trial of labour, parity, maternal age and foetal weight on the trial of labour and neonatal morbidity associated with vaginal births. Results The incidence of macrosomic babies was 2.2% of total births. Pre-existing diabetes mellitus was 3.9% of the study cohort. The rate of elective Caesarean section increased from 12.5% in non-diabetic mothers to 50% in patients with pre-existing diabetes. In cases of allowing a trial of labour, approximately 70% of patients with pre-existing diabetes had successful vaginal delivery. Patients with a previous delivery were less likely to undergo emergency procedures, but had the same probability for elective Caesarean compared with primigravida. Patient's age and foetal weight had no influence on successful trial of vaginal birth. Conclusions There was a trend to offer more elective Caesarean sections in patients with macrosomic babies in the presence of pre-existing diabetes. The majority of patients who were offered a trial of labour achieved vaginal delivery with minimal morbidity.
Collapse
Affiliation(s)
- Bedoor S. Al Omran
- Department of Radiology, Bahrain Defence Force Hospital, Riffa, Bahrain
- Corresponding address: Department of Radiology, Bahrain Defence Force Hospital, Riffa, Bahrain.
| | - Fatima H. Al Ammari
- Department of Obstetrics and Gynecology, Banoon Assisted Conception Unit, Bahrain Defence Force Hospital, Bahrain
| | - Nawal M. Dayoub
- Department of Obstetrics and Gynecology, Banoon Assisted Conception Unit, Bahrain Defence Force Hospital, Bahrain
| |
Collapse
|
20
|
Effect of Personalized Nutrition Guidance on the Birth Rate of Fetal Macrosomia in Chinese Population: A Meta-analysis of Nine Randomized Controlled Trials. Cell Biochem Biophys 2017; 72:669-74. [PMID: 27352186 DOI: 10.1007/s12013-015-0512-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of personalized nutrition guidance on birth rate of fetal macrosomia in the pooled studies. A comprehensive search was conducted to identify all eligible studies using the databases of PubMed, MEDLINE, Embase, Wanfang, Chongqing Weipu Database for Chinese Technical Periodicals and China National Knowledge Infrastructure and reference lists of relevant articles. The methodological quality of the included trials was assessed based on the Jadad scale. We used risk ratios (RRs) to assess the strength of the association, and 95 % confidence intervals (CIs) to evaluate the precision of the estimate. Heterogeneity, publication bias, and sensitivity analysis were also explored. A total of nine RCT studies, including 7,458 pregnant women, were included in the present meta-analysis. The overall results showed that personalized nutrition guidance significantly reduced the birth rate of fetal macrosomia (RR 0.289, 95 % CI 0.184-0.453, P < 0.01) in Chinese population. Simultaneously, publication bias was detected in this meta-analysis. The personalized nutrition guidance can significantly reduce the birth rate of fetal macrosomia. However, due to the limited number of RCTs, especially those with large sample size and multicenter that were quantitatively insufficient, further studies of high quality are required.
Collapse
|
21
|
Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 2016; 354:i4694. [PMID: 27624087 PMCID: PMC5021824 DOI: 10.1136/bmj.i4694] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine whether clear thresholds for identifying women at risk of perinatal outcomes can be identified. DESIGN Systematic review and meta-analysis of prospective cohort studies and control arms of randomised trials. DATA SOURCES Databases including Medline and Embase were searched up to October 2014 and combined with individual participant data from two additional birth cohorts. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies including pregnant women with oral glucose tolerance (OGTT) or challenge (OGCT) test results, with data on at least one adverse perinatal outcome. APPRAISAL AND DATA EXTRACTION Glucose test results were extracted for OGCT (50 g) and OGTT (75 g and 100 g) at fasting and one and two hour post-load timings. Data were extracted on induction of labour; caesarean and instrumental delivery; pregnancy induced hypertension; pre-eclampsia; macrosomia; large for gestational age; preterm birth; birth injury; and neonatal hypoglycaemia. Risk of bias was assessed with a modified version of the critical appraisal skills programme and quality in prognostic studies tools. RESULTS 25 reports from 23 published studies and two individual participant data cohorts were included, with up to 207 172 women (numbers varied by the test and outcome analysed in the meta-analyses). Overall most studies were judged as having a low risk of bias. There were positive linear associations with caesarean section, induction of labour, large for gestational age, macrosomia, and shoulder dystocia for all glucose exposures across the distribution of glucose concentrations. There was no clear evidence of a threshold effect. In general, associations were stronger for fasting concentration than for post-load concentration. For example, the odds ratios for large for gestational age per 1 mmol/L increase of fasting and two hour post-load glucose concentrations (after a 75 g OGTT) were 2.15 (95% confidence interval 1.60 to 2.91) and 1.20 (1.13 to 1.28), respectively. Heterogeneity was low between studies in all analyses. CONCLUSIONS This review and meta-analysis identified a large number of studies in various countries. There was a graded linear association between fasting and post-load glucose concentration across the whole glucose distribution and most adverse perinatal outcomes in women without pre-existing or gestational diabetes. The lack of a clear threshold at which risk increases means that decisions regarding thresholds for diagnosing gestational diabetes are somewhat arbitrary. Research should now investigate the clinical and cost-effectiveness of applying different glucose thresholds for diagnosis of gestational diabetes on perinatal and longer term outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013004608.
Collapse
Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
| | - Maria Bryant
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD9 6RJ, UK Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | | | | | - Su Golder
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Fidelma Dunne
- Galway Diabetes Research Centre (GDRC) and School of Medicine, National University of Ireland, Republic of Ireland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| |
Collapse
|
22
|
Cade WT, Tinius RA, Reeds DN, Patterson BW, Cahill AG. Maternal Glucose and Fatty Acid Kinetics and Infant Birth Weight in Obese Women With Type 2 Diabetes. Diabetes 2016; 65:893-901. [PMID: 26861786 PMCID: PMC4806655 DOI: 10.2337/db15-1061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/25/2016] [Indexed: 11/13/2022]
Abstract
The objectives of this study were 1) to describe maternal glucose and lipid kinetics and 2) to examine the relationships with infant birth weight in obese women with pregestational type 2 diabetes during late pregnancy. Using stable isotope tracer methodology and mass spectrometry, maternal glucose and lipid kinetic rates during the basal condition were compared in three groups: lean women without diabetes (Lean, n = 25), obese women without diabetes (OB, n = 26), and obese women with pregestational type 2 diabetes (OB+DM, n = 28; total n = 79). Glucose and lipid kinetics during hyperinsulinemia were also measured in a subset of participants (n = 56). Relationships between maternal glucose and lipid kinetics during both conditions and infant birth weight were examined. Maternal endogenous glucose production (EGP) rate was higher in OB+DM than OB and Lean during hyperinsulinemia. Maternal insulin value at 50% palmitate Ra suppression (IC50) for palmitate suppression with insulinemia was higher in OB+DM than OB and Lean. Maternal EGP per unit insulin and plasma free fatty acid concentration during hyperinsulinemia most strongly predicted infant birth weight. Our findings suggest maternal fatty acid and glucose kinetics are altered during late pregnancy and might suggest a mechanism for higher birth weight in obese women with pregestational diabetes.
Collapse
Affiliation(s)
- W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rachel A Tinius
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dominic N Reeds
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Bruce W Patterson
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| |
Collapse
|
23
|
Fotakis C, Zoga M, Baskakis C, Tsiaka T, Boutsikou T, Briana DD, Dendrinou K, Malamitsi-Puchner A, Zoumpoulakis P. Investigating the metabolic fingerprint of term infants with normal and increased fetal growth. RSC Adv 2016. [DOI: 10.1039/c6ra12403h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
An NMR metabolomic approach was employed to highlight the metabolic changes underlying prenatal disorders and determine metabolites that could serve as potential markers in relation to large for gestational age (LGA) newborns.
Collapse
Affiliation(s)
- C. Fotakis
- Institute of Biology, Medicinal Chemistry and Biotechnology
- National Hellenic Research Foundation
- Athens
- Greece
| | - M. Zoga
- Department of Neonatology
- National and Kapodistrian University of Athens
- Athens
- Greece
| | - C. Baskakis
- Institute of Biology, Medicinal Chemistry and Biotechnology
- National Hellenic Research Foundation
- Athens
- Greece
| | - Th. Tsiaka
- Institute of Biology, Medicinal Chemistry and Biotechnology
- National Hellenic Research Foundation
- Athens
- Greece
| | - T. Boutsikou
- Department of Neonatology
- National and Kapodistrian University of Athens
- Athens
- Greece
| | - D. D. Briana
- Department of Neonatology
- National and Kapodistrian University of Athens
- Athens
- Greece
| | - K. Dendrinou
- Department of Neonatology
- National and Kapodistrian University of Athens
- Athens
- Greece
| | - A. Malamitsi-Puchner
- Department of Neonatology
- National and Kapodistrian University of Athens
- Athens
- Greece
| | - P. Zoumpoulakis
- Institute of Biology, Medicinal Chemistry and Biotechnology
- National Hellenic Research Foundation
- Athens
- Greece
| |
Collapse
|
24
|
Early second-trimester serum microRNAs as potential biomarker for nondiabetic macrosomia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:394125. [PMID: 25405200 PMCID: PMC4227359 DOI: 10.1155/2014/394125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 12/13/2022]
Abstract
Background. Macrosomia has become a worldwide problem with the rapid economic growth in the past few years. However, the detailed mechanism of how the macrosomia happened remains unknown. Growing evidence indicates that miRNAs are involved in maintaining metabolic homeostasis. We hypothesized that serum miRNAs are potential biomarkers for macrosomia. Methods. We performed miRNAs profiling using TLDA chips in the discovery phase in two pooled samples from 30 cases and 30 controls, respectively. Individual qRT-PCR was conducted for the discovery phase samples. To confirm the results, we detected the miRNAs which were differentially expressed in the microarray assays and individual qRT-PCR in external validation phase with another 30 cases and 30 controls. Results. In the discovery stage, miR-194 and miR-376a expression levels were significantly different between macrosomia group and controls (P = 0.048 for miR-194 and P = 0.018 for miR-376a, resp.). Further evaluation of the two miRNAs on a total of 120 serum samples showed that the miR-376a remains significantly lower in macrosomia (P = 0.032). Receiver operating characteristic curve analyses showed that the area under curve for miR-376a was 67.8% (sensitivity = 96.7% and specificity = 40.0%). Conclusions. Serum miR-376a may serve as a potential noninvasive biomarker in detecting macrosomia.
Collapse
|
25
|
Zhu M, Cai J, Liu S, Huang M, Chen Y, Lai X, Chen Y, Zhao Z, Wu F, Wu D, Miu H, Lai S, Chen G. Relationship between gestational fasting plasma glucose and neonatal birth weight, prenatal blood pressure and dystocia in pregnant Chinese women. Diabetes Metab Res Rev 2014; 30:489-96. [PMID: 24665054 DOI: 10.1002/dmrr.2544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the optimal cut-off point of fasting plasma glucose for the diagnosis of gestational diabetes mellitus for pregnant Chinese women. This study investigates the relationship between gestational fasting plasma glucose and several variables: neonatal birth weight, prenatal blood pressure and dystocia rate of pregnant women. In this study, we hoped to provide a useful tool to screen gestational diabetes mellitus in pregnant Chinese women. METHODS For 1058 pregnant women enrolled in our hospital at pregnancy weeks 22-30, fasting plasma glucose, neonatal birth weight and prenatal blood pressure, as well as dystocia conditions, were examined. We analysed the correlations between the following: gestational fasting plasma glucose and neonatal birth weight; prenatal blood pressure and gestational fasting plasma glucose as well as dystocia rate and gestational fasting plasma glucose group. RESULTS A modest correlation was observed between gestational fasting plasma glucose and neonatal birth weight (r = 0.093, p = 0.003). The macrosomia rate was smallest when the gestational fasting plasma glucose was in the range 3.51-5.5 mmol/L. Prenatal blood pressure increased linearly with increasing gestational fasting plasma glucose (p = 0.000). There was a significant difference between the dystocia rates in different fasting plasma glucose groups (chi-squared = 13.015, p = 0.043). The results showed that the dystocia rate significantly increased when gestational fasting plasma glucose was >4.9 mmol/L; p = 0.03, OR = 2.156 (95% CI, 1.077-4.318). CONCLUSION We suggest that the optimal range of gestational fasting plasma glucose for pregnant Chinese women is in the range 3.5-4.9 mmol/L.
Collapse
Affiliation(s)
- Min Zhu
- Department of Endocrinology, The Second People's Hospital of Fujian province, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Skilton MR, Siitonen N, Würtz P, Viikari JSA, Juonala M, Seppälä I, Laitinen T, Lehtimäki T, Taittonen L, Kähönen M, Celermajer DS, Raitakari OT. High birth weight is associated with obesity and increased carotid wall thickness in young adults: the cardiovascular risk in young Finns study. Arterioscler Thromb Vasc Biol 2014; 34:1064-8. [PMID: 24626439 DOI: 10.1161/atvbaha.113.302934] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is some evidence that people born with high birth weight may be at increased risk of cardiovascular disease in adulthood. Details of the underlying mechanisms remain unknown. We sought to determine whether people born large for gestational age have poor arterial health, increased adiposity, and a poor cardiovascular risk factor profile. APPROACH AND RESULTS Carotid intima-media thickness, brachial flow-mediated dilatation, and cardiovascular risk factors were compared between young adults (24-45 years) born at term who were large for gestational age (birth weight >90th percentile; n=171), and a control group with normal birth weight (50-75th percentile; n=525), in the Cardiovascular Risk in Young Finns Study. Those born large for gestational age had higher body mass index throughout childhood, adolescence, and as young adults (26.4 kg/m(2) [SD 4.9], versus normal birth weight 25.1 kg/m(2) [SD 4.6]; P=0.002), and 2-fold greater risk of obesity. Other cardiovascular risk factors and arterial function did not differ; however, carotid intima-media thickness was increased in people born large for gestational age (0.60 mm [SD 0.09], versus normal birth weight 0.57 mm [SD 0.09]; P=0.003), independent of cardiovascular risk factors (P=0.001 after adjustment). Both obesity and high birth weight were independently associated with carotid intima-media thickness in a graded and additive fashion. CONCLUSIONS Young adults born large for gestational age are more likely to be obese, yet have an otherwise healthy cardiovascular risk profile. Nonetheless, they have increased carotid intima-media thickness, a marker of subclinical atherosclerosis, consistent with an increased risk of cardiovascular disease.
Collapse
Affiliation(s)
- Michael R Skilton
- From the Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders (M.R.S), and Sydney Medical School (D.S.C.), University of Sydney, Sydney, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine (N.S., M.J., O.T.R.), Department of Clinical Physiology and Nuclear Medicine (O.T.R.), and Department of Medicine (J.S.A.V., M.J.), University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland (T. Laitinen); Department of Clinical Chemistry, Fimlab Laboratories (I.S., T. Lehtimäki), and Department of Clinical Physiology (M.K.), University of Tampere and Tampere University Hospital, Tampere, Finland; Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland (P.W.); and Department of Pediatrics, University of Oulu, Oulu, and Department of Pediatrics, Vaasa Central Hospital, Vaasa, Finland (L.T.)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Mohammadbeigi A, Farhadifar F, Soufi Zadeh N, Mohammadsalehi N, Rezaiee M, Aghaei M. Fetal macrosomia: risk factors, maternal, and perinatal outcome. Ann Med Health Sci Res 2013; 3:546-50. [PMID: 24380006 PMCID: PMC3868121 DOI: 10.4103/2141-9248.122098] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Macrosomia is defined as birth-weight over 4,000 g irrespective of gestational age and affects 3-15% of all pregnancies. Aim The present study aimed to determine the relationship between mother's characteristics and macrosomic births and also compare macrosomic and normal newborns regarding the maternal and offspring complications of diabetes during pregnancy. SUBJECTS AND METHODS In this case control study, among the 420 consecutive births occurring in public and private hospitals of Shiraz, Iran from October 2006 to March 2007, the data of 32 macrosomic and 128 normal newborns were analyzed using t-test and chi square in bivariate and logistic regression in multivariate model. RESULTS The mean (SD) of neonate weight, height, and head size was 3323.4 (709), 48.95 (3.2), and 34.9 (1.8), respectively. Regression analysis showed that gestational diabetes (Odds Ratio (OR): 11.9, Confidence Interval (CI): 4.6-30.3), preeclampsia in the pregnancy period due to diabetes (OR: 3.81, CI: 1.1-13.2), and macrosomic birth history (OR: 3.3, CI: 1.04-10.4) were the main predictors of macrosomia. Moreover, macrosomia increased neonate hypoglycemia (OR: 4.7, CI: 1.4-15.8) and section delivery (OR: 4.1, CI: 1.27-13.1). CONCLUSION Gestational diabetes, preeclampsia due to diabetes, and history of macrosomic birth were the main predictors of macrosomia. Moreover, macrosomia increased some delivery complications for both mothers and newborns.
Collapse
Affiliation(s)
- A Mohammadbeigi
- Department of Public Health, School of Health, Qom University of Medical Sciences and Health Services, Qom, Iran
| | - F Farhadifar
- Department of Gynecology and Obstetrics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - N Soufi Zadeh
- Department of Gynecology and Obstetrics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - N Mohammadsalehi
- Health Vice chancellor, Arak University of Medical Sciences and Health Services, Arak, Iran
| | - M Rezaiee
- Department of Gynecology and Obstetrics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - M Aghaei
- Hazrate Masoumeh Hospital, Qom University of Medical Sciences and Health Services, Qom, Iran
| |
Collapse
|
28
|
Dalfrà MG, Chilelli NC, Di Cianni G, Mello G, Lencioni C, Biagioni S, Scalese M, Sartore G, Lapolla A. Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes. Int J Endocrinol 2013; 2013:279021. [PMID: 24319455 PMCID: PMC3844274 DOI: 10.1155/2013/279021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/19/2013] [Accepted: 09/30/2013] [Indexed: 01/12/2023] Open
Abstract
Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.
Collapse
Affiliation(s)
- M. G. Dalfrà
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - N. C. Chilelli
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - G. Di Cianni
- Department of Endocrinology & Metabolism, Section of Metabolic Diseases & Diabetes, AOUP Pisa, University of Pisa, Ospedale Cisanello, Via Paradisa no. 2, 56124 Pisa, Italy
| | - G. Mello
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale Giovan Battista Morgagni no. 85, 50134 Florence, Italy
| | - C. Lencioni
- Department of Endocrinology & Metabolism, Section of Metabolic Diseases & Diabetes, AOUP Pisa, University of Pisa, Ospedale Cisanello, Via Paradisa no. 2, 56124 Pisa, Italy
| | - S. Biagioni
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale Giovan Battista Morgagni no. 85, 50134 Florence, Italy
| | - M. Scalese
- CNR, Institute of Clinical Physiology, Via G. Moruzzi no. 1, 56124 Pisa, Italy
| | - G. Sartore
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| | - A. Lapolla
- Department of Medicine, Unit of Metabolic Diseases, University of Padua, Via Giustiniani no. 2, 35128 Padua, Italy
| |
Collapse
|
29
|
Saleh J, Machado L, Razvi Z. 2-Hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in "appropriate for gestational age" neonates in healthy nondiabetic pregnancies. BIOMED RESEARCH INTERNATIONAL 2013; 2013:757459. [PMID: 24151621 PMCID: PMC3789359 DOI: 10.1155/2013/757459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/03/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Increased neonatal birth weight (NBW), often associated with diabetic pregnancies, is a recognized indicator of childhood obesity and future metabolic risk. Predictors of NBW in healthy non-diabetic pregnancies are not yet established. Here, we investigated the association of maternal parameters of healthy non-diabetic mothers with NBW of their "appropriate-for-gestational age" neonates. METHODS The study involved 36 healthy mother/infant pairs. Examined parameters included NBW, maternal age, first and last trimester (BMI), weight gain, fasting serum lipids and glucose, 2-hour postload glucose levels and blood pressure. RESULTS Postload-glucose levels were significantly higher in mothers of heavier neonates. ANOVA results indicated that 15% increase in postload-glucose levels corresponded to more than 0.5 Kg increase in NBW in the third tertile. NBW correlated positively with postload glucose levels, and negatively with systolic blood pressure. Regression analysis showed that the main predictors of NBW were postload-glucose levels (B = 0.455, P = 0.003), followed by systolic blood pressure (B = -0.447, P = 0.004), together predicting 31.7% NBW variation. CONCLUSION This study highlights that increased maternal postload sugar levels and blood pressure, within the normal range, highly predicts NBW of healthy mothers. These findings may provide focus for early dietary intervention measures to avoid future risks to the mother and baby.
Collapse
Affiliation(s)
- Jumana Saleh
- Biochemistry Department, College of Medicine, Sultan Qaboos University, P.O. Box 35, 123, Muscat, Oman
| | - Lovina Machado
- Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University Hospital, P.O. Box 35, 123, Muscat, Oman
| | - Zahra Razvi
- College of Medicine, Sultan Qaboos University, P.O. Box 35, 123, Muscat, Oman
| |
Collapse
|
30
|
H Nagy K, Pomucz J, Varga R, Szabó E, Soltész G. [Anthropometric data, fetal and neonatal complications in infants of diabetic mothers. Results of a 10-year retrospective study]. Orv Hetil 2013; 154:172-7. [PMID: 23395742 DOI: 10.1556/oh.2013.29540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Disturbances in carbohydrate metabolism during pregnancy may result in harmful fetal and neonatal consequences. OBJECTIVES To assess the fetal and neonatal complications of pregnancy in mothers with gestational and pregestational diabetes during a 10-year period in a county hospital in Hungary. METHODS Retrospective analysis of infants of diabetic mothers admitted to the neonatal unit between 2001 and 2010. RESULTS 32% of the infants were transferred to the neonatal unit. Neonatal macrosomia (birth weight >90 centile) was observed in one quarter of the infants. 39% of the infants developed hypoglycemia (blood glucose <2.6 mmol/l), in the majority of the cases within the first 8 hours. Hypoglycaemia was symptomatic in 55% of the infants. Hypocalcemia was observed in 17%, hyperviscosity in 23%, hyperbilirubinaemia in 32%, respiratory distress syndrome and/or transient tachypnoe in 22% and cardiac complications in 13% of the infants. 10% of the inafnts were affected with birth injuries. Congenital anomalies were seen in 17% of the cases, and severe malformations were present in 4% of the infants. CONCLUSIONS Despite modern diabetes management, there is still a higher incidence of fetal macrosomia, adverse neonatal outcomes and a higher rate of severe congenital malformations in neonates of diabetic mothers.
Collapse
Affiliation(s)
- Katalin H Nagy
- Pándy Kálmán Megyei Kórház Gyermekosztály Gyula Kárpát u. 11. 5700.
| | | | | | | | | |
Collapse
|
31
|
Davies H, Visser J, Tomlinson M, Rotheram-Borus M, Gissane C, Harwood J, LeRoux I. An investigation into utilising gestational body mass index as a screening tool for adverse birth outcomes and maternal morbidities in a group of pregnant women in Khayelitsha. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2013; 26:116-122. [PMID: 25324710 PMCID: PMC4196873 DOI: 10.1080/16070658.2013.11734455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the ability of the gestational body mass index (BMI) method to screen for adverse birth outcomes and maternal morbidities. DESIGN This was a substudy of a randomised controlled trial, the Philani Mentor Mothers' study. SETTING AND SUBJECTS The Philani Mentor Mothers' study took place in a peri-urban settlement, Khayelitsha, between 2009 and 2010. Pregnant women living in the area in 2009-2010 were recruited for the study. OUTCOME MEASURES Maternal anthropometry (height and weight) and gestational weeks were obtained at baseline to calculate the gestational BMI, which is maternal BMI adjusted for gestational age. Participants were classified into four gestational BMI categories: underweight, normal, overweight and obese. Birth outcomes and maternal morbidities were obtained from clinic cards after the births. RESULTS Pregnant women were recruited into the study (n = 1 058). Significant differences were found between the different gestational BMI categories and the following birth outcomes: maternal (p-value = 0.019), infant hospital stay (p-value = 0.03), infants staying for over 24 hours in hospital (p-value = 0.001), delivery mode (p-value = 0.001), birthweight (p-value = 0.006), birth length (p-value = 0.007), birth head circumference (p-value = 0.007) and pregnancy-induced hypertension (p-value = 0.001). CONCLUSION To the best of our knowledge, this is the first study that has used the gestational BMI method in a peri-urban South African pregnant population. Based on the findings that this method is able to identify unfavourable birth outcomes, it is recommended that it is implemented as a pilot study in selected rural, peri-urban and urban primary health clinics, and that its ease and effectiveness as a screening tool is evaluated. Appropriate medical and nutritional advice can then be given to pregnant women to improve both their own and their infants' birth-related outcomes and maternal morbidities.
Collapse
Affiliation(s)
- Hr Davies
- Division of Human Nutrition, Stellenbosch University
| | - J Visser
- Division of Human Nutrition, Stellenbosch University
| | - M Tomlinson
- Department of Psychology, Stellenbosch University
| | - Mj Rotheram-Borus
- Semel Institute and the Department of Psychiatry University of California, Los Angeles, USA
| | - C Gissane
- School of Human and Applied Science, St Mary's University College, Twickenham, UK
| | - J Harwood
- Semel Institute and the Department of Psychiatry University of California, Los Angeles, USA
| | - I LeRoux
- Philani Child Health and Nutrition Centre, Khayelitsha
| |
Collapse
|
32
|
Mazze R, Yogev Y, Langer O. Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy. J Matern Fetal Neonatal Med 2012; 25:1171-5. [DOI: 10.3109/14767058.2012.670413] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Whitmore GA, Zhang G, Lee MLT. Constructing normalcy and discrepancy indexes for birth weight and gestational age using a threshold regression mixture model. Biometrics 2012; 68:297-306. [PMID: 21838731 PMCID: PMC6431588 DOI: 10.1111/j.1541-0420.2011.01648.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Birth weight and gestational age are important measures of a newborn's intrinsic health, serving both as outcome measures and explanatory variables in health studies. The measures are highly correlated but occasionally inconsistent. We anticipate that health researchers and other scientists would be helped by summary indexes of birth weight and gestational age that give more precise indications of whether the birth outcome is healthy or not. We propose a pair of indexes that we refer to as the birth normalcy index or BNI and birth discrepancy index or BDI. Both indexes are simple functions of birth weight and gestational age and in logarithmic form are orthogonal by construction. The BNI gauges whether the birth weight and gestational age combination are in a normal range. The BDI gauges whether birth weight and gestational age are consistent. We present a three-component mixture model for BNI, with the components representing premature, at-risk, and healthy births. The BNI distribution is derived from a stochastic model of fetal development proposed by Whitmore and Su (2007, Lifetime Data Analysis 13, 161-190) and takes the form of a mixture of inverse Gaussian distributions. We present a noncentral t-distribution as a model for BDI. BNI and BDI are also well suited for making comparisons of birth outcomes in different reference populations. A simple z-score and t-score are proposed for such comparisons. The BNI and BDI distributions can be estimated for births in any reference population of interest using threshold regression.
Collapse
Affiliation(s)
- G. A. Whitmore
- McGill University, Montreal, and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Guangyu Zhang
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, U.S.A
| | - Mei-Ling Ting Lee
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, U.S.A
- National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
34
|
Yachi Y, Tanaka Y, Anasako Y, Nishibata I, Saito K, Sone H. Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study. Diabetes Res Clin Pract 2011; 92:293-8. [PMID: 21396732 DOI: 10.1016/j.diabres.2011.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/30/2011] [Accepted: 02/08/2011] [Indexed: 11/30/2022]
Abstract
AIMS To clarify risk factors predictive of glucose intolerance in later pregnancy. METHODS We prospectively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation, between September 2008 and January 2010. Biochemical parameters were measured in fasting plasma samples collected at week 8.0 ± 2.0 of gestation. A 50 g glucose challenge test (GCT) was performed between weeks 26 and 29: plasma glucose levels ≥ 7.8 mmol/l 1h after ingestion indicated a positive GCT. Logistic regression was performed, adjusting for relevant covariates. RESULTS We identified 114 patients with positive GCTs, including 8 with gestational diabetes mellitus (GDM). After correcting for baseline body mass index, only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity (OR 2.07; 1.21-3.55). We identified threshold values of fasting plasma glucose (FPG) ≥ 3.66 mmol/l and fasting plasma insulin (FPI) ≥ 36.69 pmol/l as indicative of a higher risk of positive GCT (OR 2.38; 1.49-3.80). CONCLUSIONS First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity.
Collapse
Affiliation(s)
- Yoko Yachi
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | | | | | | | | | | |
Collapse
|
35
|
Naver KV, Lundbye-Christensen S, Gorst-Rasmussen A, Nilas L, Secher NJ, Rasmussen S, Ovesen P. Parity and risk of diabetes in a Danish nationwide birth cohort. Diabet Med 2011; 28:43-7. [PMID: 21166844 DOI: 10.1111/j.1464-5491.2010.03169.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The purpose was to elucidate the association between parity and the incidence of diabetes using national register data. METHODS The study population consisted of all Danish women with a singleton delivery in 1982/1983 (n = 100,669), who subsequently had 74,966 deliveries. The included women were followed up via registries until the end of 2006 for subsequent deliveries, diagnosis of diabetes and death/emigration. RESULTS A total of 2021 cases (2.0%) were diagnosed with diabetes in connection with hospitalization or outpatient treatment during follow-up. Analyses were adjusted for fetal weight and duration of gestation, both at index pregnancy. Cox regression analysis with parity as a time-varying exposure, stratified in two age groups, showed an association between parity and risk of a diagnosis of diabetes. In women <33 years of age, parity 2, 3 and 4 + were associated with an increased risk of being diagnosed with diabetes compared with parity 1 [relative risks: 1.6 (95% confidence interval 1.1-2.3), 2.8 (1.8-4.3) and 2.5 (1.3-4.8), respectively]. Among women >33 years of age, parity 2 was associated with a significantly lower risk of diabetes diagnosis compared with parity 1, whereas parity 4 + was associated with a significantly higher risk of diabetes diagnosis compared with parity 1. CONCLUSIONS The study shows that the risk of diabetes diagnosis increases with parity in young Danish women. This may support a causal association between diabetes and parity.
Collapse
Affiliation(s)
- K V Naver
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark.
| | | | | | | | | | | | | |
Collapse
|