Birth weight of women with gestational diabetes

Infants of Diabetic Mothers and Associated Complications in the Neonatal Intensive Care Unit

Background The incidence of pregnancy-associated diabetes has increased in recent decades, leading to neonatal adverse outcomes like metabolic and hematologic disorders, respiratory distress, cardiac disorders, and neurologic impairment. Macrosomia, a common consequence of diabetes, is influenced by maternal blood glucose levels, impacting adverse neonatal outcomes. Aim The current study aimed to assess the neonatal and maternal outcomes of the infants of diabetic mothers. Methods An observational retrospective study was conducted among infants of diabetic mothers at Maternity and Children Hospital, Saudi Arabia, from 2022 to 2023. The data included socio-demographic details, diabetes-related information, and maternal and neonatal outcomes.  Results A study of 400 mothers aged 18-40 years found that 54.3% had 1-4 previous pregnancies, while 35.5% had more than four. The majority had gestational diabetes mellitus (GDM), with 25.5% having diabetes for more than five years. The most common complications were preeclampsia (7.5%), polyhydramnios (6%), UTI (5.3%), PROM (4.3%), and pregnancy-induced hypertension (4.3%). The majority had no complications, while 12.5% of neonates had respiratory and metabolic complications. Conclusion The study found that most women with gestational diabetes had previously been diagnosed with diabetes mellitus (DM) and are multiparous, with Caesarean delivery being the dominant mode. While maternal complications were seen in only less than one-third of mothers, neonatal complications were noted in 12.5%.

Intrauterine hyperglycemia induces intergenerational Dlk1-Gtl2 methylation changes in mouse placenta

An intrauterine hyperglycemic environment has long-lasting effects on the offspring. Recent studies focused on fetal tissues, whereas we studied the development and molecular alteration of the placenta. By intercrossing male and female adult control (C) and first-generation offspring mice with gestational diabetes mellitus (F1-GDM), we obtained four groups of second generation (F2) offspring: 1) C♂-C♀, 2) C♂-GDM♀, 3) GDM♂-C♀, 4) GDM♂- GDM♀. Placental weights in F1-GDM offspring were lower than in the control group. Placental weights in F2-offspring decreased through the paternal line. Placental RNA was extracted and analyzed using microarrays on day18.5 of pregnancy. This revealed 35 upregulated imprinted genes and 10 down-regulated imprinted genes. Dlk1and Gtl2 were especially down-regulated and up-regulated, respectively, due to their abnormal methylation status. These findings suggest that intrauterine hyperglycemia decreased placental weight in the first generation, and this was transmitted paternally to the second generation in mice. They also suggest intrauterine hyperglycemia leads to abnormal placental Dlk1-Gtl2 expression due to DNA methylation in first and second generation mice.

Ponderal index at birth associates with later risk of gestational diabetes mellitus

PURPOSE

Low birth weight (BW) and low ponderal index (PI) are associated with increased risk of type 2 diabetes mellitus. This study has two purposes: first to investigate the influence of PI on the risk of gestational diabetes mellitus (GDM); second, to study the association between glucose metabolism and BW in women with previous GDM.

METHODS

GDM cohort: 185 women with GDM in 1978-1996, attending a follow-up study in 2000-2002. Control cohort: 1137 women from a population-based diabetes screening study (Inter99) in a neighbouring county in 1999-2001. BW and birth length were collected from the original midwifery records. BW and PI were stratified into tertiles for analysis.

RESULTS

PI in the lower tertiles was associated with an increased risk of GDM [odds ratio 1.59 (95% confidence interval 1.07-2.36, p = 0.021)]. Among women with previous GDM, the area under the curve (AUC) for plasma levels of glucose and insulin during an OGTT was highest for the lower tertiles of BW (for AUCglucose p = 0.048, for AUCinsulin p = 0.047 adjusted for age and BMI).

CONCLUSIONS

Lower PI is associated with increased risk of GDM. In women with previous GDM, lower BW is associated with a more severe impairment of glucose metabolism one to two decades after the pregnancy complicated by GDM.

The relation of a woman’s impaired in utero growth and association of diabetes during pregnancy

Small for gestational age (weight for gestational age <10th percentile, SGA) birth status and adulthood susceptibility to diabetes is well established, but the relationship to diabetes during pregnancy is incompletely understood. The authors investigated the association between women's impaired fetal growth (as measured by SGA status) and diabetes mellitus (DM) during pregnancy. Stratified and multivariable binomial regression analyses were performed on the Illinois transgenerational dataset. Former SGA (n = 13,934) mothers had a greater prevalence of DM during pregnancy than former appropriate for gestational age (AGA) mothers (n = 116,683): 2.7 versus 1.9 %, relative prevalence (RP) equaled 1.4 [95 % confidence interval (CI)1.3, 1.6]. In a multivariable binomial regression model, the adjusted RP (95 %CI) (controlling for maternal age, education, parity, plurality, marital status, and race/ethnicity) for DM during pregnancy for former SGA (compared to AGA) mothers equaled 1.5 (1.3, 1.6). When stratified by race/ethnicity, the adjusted RP (95 % CI) of DM during pregnancy for former SGA (compared to AGA), non-Latina White, African-American, and Mexican-American mothers was 1.4 (1.3, 1.6), 1.6 (1.2, 2.1), and 2.3 (1.1, 4.7), respectively. The authors conclude that impaired fetal growth (as measured by SGA status) is a risk factor for DM during pregnancy among the leading racial/ethnic groups in the United States.

From infancy to pregnancy: birth weight, body mass index, and the risk of gestational diabetes

Obesity is a risk factor for gestational diabetes, whereas the role of the mother's birth weight is more uncertain. We aimed to investigate the combined effect of mothers' birth-weight-for-gestational-age and early pregnancy Body Mass Index (BMI) in relation to risk of gestational diabetes. Between 1973 and 2006, we identified a cohort of 323,083 women included in the Swedish Medical Birth Register both as infants and as mothers. Main exposures were mothers' birth-weight-for-gestational-age (categorized into five groups according to deviation from national mean birth weight) and early pregnancy BMI (classified according to WHO). Rates of gestational diabetes increased with adult BMI, independently of birth-weight-for-gestational-age. However, compared to women with appropriate birth-weight-for-gestational-age [appropriate-for-gestational age (AGA); -1 to +1 SD] and BMI (<25.0), women with obesity class II-III (BMI ≥ 35.0) had an adjusted odds ratio (OR) of 28.7 (95 % confidence interval, CI 17.0-48.6) for gestational diabetes if they were born small-for-gestational-age [small for gestational age (SGA); <-2SD], OR = 20.3 (95 % CI 11.8-34.7) if born large-for-gestational-age [large-for-gestational-age (LGA); >2SD], and OR = 10.4 (95 % CI 8.4-13.0) if born AGA. Risk of gestational diabetes is not only increased among obese women, but also among women born SGA and LGA. Severely obese women born with a low or a high birth-weight-for-gestational-age seem more vulnerable to the development of gestational diabetes compared to normal weight women. Normal pre-pregnancy BMI diminishes the increased risk birth size may confer in terms of gestational diabetes. Therefore, the importance of keeping a healthy weight cannot be overemphasized.

Definition, epidemiology, risk factors

Gestational diabetes mellitus is defined as glucose intolerance that begins or is first recognized during pregnancy. Its prevalence, generally situated between 2-6%, may reach 10-20% in high-risk populations, with an increasing trend across most racial/ethnic groups studied. Among traditional risk factors, previous gestational diabetes, advanced maternal age and obesity have the highest impact on gestational diabetes risk. Racial/ethnic origin and family history of type 2 diabetes have a significant but moderate impact (except for type 2 diabetes in siblings). Several non traditional factors have been recently characterized, either physiological (low birthweight and short maternal height) or pathological (polycystic ovaries). The multiplicity of risk factors and their interactions results in a low reliability of risk prediction on an individual basis.

Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature

Age, obesity and family history of diabetes are well known risk factors for gestational diabetes mellitus. Others are more controversial. The objective of this review is to find evidence in the literature that justifies the inclusion of these other conditions among risk factors. The MEDLINE, Cochrane, LILACS and Pan American Health Organization databases were searched, covering articles dating from between 1992 and 2006. Keywords were used in combination (AND) with gestational diabetes mellitus separately and with each one of the risk factors studied. The methodological quality of the studies included was assessed, resulting in the selection of 41 papers. Most studies investigating maternal history of low birth weight, low stature, and low level of physical activity have found positive associations with gestational diabetes mellitus. Low socioeconomic levels, smoking during pregnancy, high parity, belonging to minority groups, and excessive weight gain during pregnancy presented conflicting results. Publication bias cannot be ruled out. Standardization of techniques, cutoff points for screening and diagnosis, as well as studies involving larger sample sizes would allow future meta-analyses.

Gestational Diabetes Mellitus Outcome in 394 Patients

OBJECTIVE

To determine whether women with gestational diabetes mellitus (GDM) and their offspring have pregnancy outcomes and complications of pregnancy that are different from those in the general obstetric population.

METHODS

Through medical record coding, we identified women with GDM and a singleton pregnancy with cephalic presentation who delivered at St. Paul's Hospital between January 1, 1995, and December 31, 2001. In total, 394 births were analyzed and their outcomes compared with those of a control group of 100 non-diabetic women with the same gestational age (38 weeks) at delivery.

RESULTS

Women with gestational diabetes were of lesser parity (P 0.05), appreciably older (P 0.05), and less likely to be Caucasian (P 0.005) than the general obstetric population. Women with GDM also had a higher risk of Caesarean section (P 0.05), gestational hypertension (P 0.05), and large for gestational age (LGA) deliveries (P 0.005). Of women with GDM, those treated with insulin had a higher incidence of LGA deliveries than those on diet therapy alone. The incidence of respiratory distress syndrome and of need for phototherapy was similar in babies whose mothers had GDM and in those whose mothers did not.

CONCLUSION

Although the rate of complications remains low, GDM creates a predisposition to increased maternal and neonatal complications.

Maternal birth weight in relation to plasma lipid concentrations in early pregnancy

OBJECTIVE

The purpose of this study was to determine the extent to which, if at all, maternal weight at birth is related to dyslipidemia during early pregnancy, which is a risk factor for preeclampsia.

STUDY DESIGN

This hospital-based prospective cohort study included 1000 women who initiated prenatal care before 16 weeks of gestation. Participants provided information about their birth weight and other sociodemographic and reproductive covariates. Plasma triglyceride, high-density lipoprotein cholesterol, and total cholesterol concentrations were measured at approximately 13 weeks of gestation. beta coefficients and standard errors were estimated by multiple linear regression; odds ratios and 95% confidence intervals were estimated by logistic regression.

RESULTS

Maternal birth weight was correlated negatively with triglycerides (r =-0.12; P =.001) and was correlated positively with high-density lipoprotein cholesterol (r =0.08; p =.02) but not statistically significantly related with total cholesterol (r =-0.004; P=.91). After adjusting for potential confounders, women who weighed <2500 g at birth had higher triglyceride and total cholesterol concentrations (beta=23.4 mg/dL [P<.001]; beta =2.6 mg/dL [P =.585], respectively) and lower high-density lipoprotein cholesterol concentrations (beta =-3.2 mg/dL; P=.105), when compared with women who weighed 3000 to 3499 g at birth. Women who were born small (<2500 g) and became overweight (body mass index, >or=25 kg/m(2)) in adulthood had less favorable lipid profiles than their counterparts who weighed >or=2500 g at birth and remained lean (body mass index, <25 kg/m(2)).

CONCLUSION

Our findings suggest that factors that are related to growth in utero may help to predict the subsequent risk of altered lipid metabolism during pregnancy, which may, in turn, be causally related to the occurrence of preeclampsia.

Weight at birth and subsequent risk of preeclampsia as an adult

OBJECTIVE

We examined the influence of maternal birth weight on the risk of the development of preeclampsia, a likely precursor to adult chronic disease.

STUDY DESIGN

This hospital-based case-control study included 181 preeclampsia cases and 349 control subjects. Participants provided information about their birth weight and other covariates that included medical and reproductive history, prepregnancy weight, and adult height. Odds ratios and 95% CIs were estimated by logistic regression.

RESULTS

The risk of preeclampsia decreased as maternal birth weight increased (P=.01). After an adjustment was made for confounders, data showed that women with a low birth weight (<2500 g) had a 2.3-fold increased risk of experiencing preeclampsia (95% CI, 1.0-5.3) as compared with women who weighed 2500 to 2999 g at birth. Conversely, women with a birth weight of >/=4000 g appeared to have a nonstatistically significant, but >50%, reduction in the risk of experiencing preeclampsia (95% CI, 0.2-1.2). This relationship differed for lean and overweight women (body mass index, <25 kg/m(2) vs >/=25 kg/m(2)). Among lean women, those who were low birth weight had a near doubling in risk of the development of preeclampsia (odds ratio, 1.9; 95% CI, 0.8-4.6), although this association did not reach statistical significance. However, among overweight women, those women who weighed <2500 g at birth had an almost 4-fold increased risk of experiencing preeclampsia (odds ratio, 3.8; 95% CI, 1.1-13.8).

CONCLUSION

These results confirm two earlier reports and expand the literature by showing that women who are small at birth and who become overweight as adults are at particularly high risk of the development of preeclampsia.

Relationship between gestational diabetes mellitus and low maternal birth weight

OBJECTIVE

To study the relationship between low birth weight and the presence of gestational diabetes mellitus (GDM) or peripheral insulin resistance during pregnancy.

RESEARCH DESIGN AND METHODS

We studied the relationship between peripheral insulin sensitivity (calculated by Matsuda and DeFronzo's oral glucose tolerance test (OGTT)-derived insulin sensitivity index [ISI(OGTT)]) or GDM prevalence and birth weight in 604 pregnant women, classified as normally glucose tolerant (n = 462) or affected with GDM (n = 142) after a 100-g 3-h oral glucose tolerance test. We then categorized these subjects into two groups: individuals with birth weight in the <10th percentile (<2,600 g; n = 68) and individuals with birth weight in the >10th percentile (n = 536).

RESULTS

GDM prevalence was higher in the group in the lowest birth weight decile (<2,600 g; 24/68; 35%) than in the group with normal/high birth weight (118/536; 22%; chi(2) = 5.917; P = 0.01). Relative risk for GDM adjusted for age, parity, family history of diabetes, and prepregnancy body weight was about twofold in the group with low birth weight (odds ratio = 1.89 [95% CI 1.088-3.285; P = 0.023]), and the prevalence of low birth weight was about threefold higher in the first ISI(OGTT) decile. In 450 women whose newborn's weight was known, the delivery of macrosomic babies was associated with a twofold higher relative risk for GDM in women who themselves had low birth weight. In the latter, the relationships between their newborn's weight and either maternal glucose tolerance (positive) or ISI(OGTT) (negative) were amplified.

CONCLUSIONS

Low maternal birth weight was associated with a twofold higher risk for GDM, independent of major confounders. Such a risk was highest in women with low birth weight who delivered macrosomic babies, and in the group with low birth weight, the relationship between maternal glucose tolerance or insulin resistance and offspring's neonatal weight was much more evident.