Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

Neuropsychological development of large for gestational age infants at the age of 12 months / 中国当代儿科杂志

OBJECTIVES@#To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months.@*METHODS@#The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age.@*RESULTS@#After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05).@*CONCLUSIONS@#The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.

Identifying susceptible exposure windows for ambient nitrogen dioxide before and during pregnancy and increased risks of small/large for gestational age / 环境与职业医学

Background Exposure to ambient nitrogen dioxide (NO2) could increase the risks of small for gestational age (SGA) and large for gestational age (LGA). Nevertheless, previous published studies usually use a time period over relatively long durations as the exposure window, such as trimester-specific or gestational months, to identify adverse pregnancy outcomes related susceptible exposure windows for ambient air pollution. At present, no study has explored associations of weekly-specific ambient air NO2 exposure around pregnancy with SGA and LGA. Objective To evaluate the associations of exposure to ambient NO2 over the preconception and entire pregnancy period with risks of SGA and LGA, as well as to explore critical windows of NO2 exposure by refining exposure period to specific weeks. Methods Based on a birth cohort established by the project Environmental and LifEstyle FActors iN metabolic health throughout life-course Trajectories (ELEFANT) situated in Tianjin, 10 916 singleton pregnant women whose dates of the last menstrual period and delivery were both between June 2014 and June 2016, and whose gestational age were within 24-42 completed gestational weeks were included in this study. Each pregnant woman's exposures to ambient NO2 throughout 12 weeks before pregnancy and pregnancy period were matched with daily average NO2 concentrations obtained from the Chinese air quality reanalysis datasets (CAQRA). Distributed lag models incorporated in Cox proportional hazard regression models were applied to explore the associations of maternal exposure to weekly ambient NO2 throughout 12 weeks before pregnancy and pregnancy period with risks of SGA and LGA after controlling for potential confounders including maternal age, ethnicity, educational level, occupation, body mass index before pregnancy, residence, times of gravidity and parity, smoking, alcohol consumption, husband smoking, and season of conception. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated per 3 μg·m−3 increase in ambient NO2 concentrations. Results The average levels of maternal exposure to NO2 over the preconception, first trimester, second trimester, third trimester, and entire pregnancy periods were (39.6±10.8), (42.7±10.5), (44.8±12.7), (37.7±11.1), and (41.6±4.8) μg·m−3, respectively. For a 3 μg·m−3 increase in NO2 over the first trimester, the risk of SGA increased by 19.0% (95%CI: 8.0%-32.0%). For a 3 μg·m−3 increase in NO2 over the preconception, first trimester, and entire pregnancy, the associated risks of LGA increased by 7.0% (95%CI: 1.0%-13.0%), 37.0% (95%CI: 29.0%-46.0%) and 19.0% (95%CI: 9.0%-31.0%), respectively. For SGA, the susceptible exposure windows for NO2 were observed during the 7th to 12th preconceptional weeks and the 6th to 12th gestational weeks, with the strongest association found at the 12th preconceptional week, when the risk of SGA increased by 6.0% (95%CI:3.2%-8.9%) for a 3 μg·m−3 increase in NO2. For LGA, the susceptible exposure windows for NO2 were observed during the 1st to 12th preconceptional weeks and the 1st to 6th gestational weeks, with the strongest association found at the 12th preconceptional week, when the risk of LGA increased by 6.1% (95%CI: 4.5%-7.8%) for a 3 μg·m−3 increase in NO2. Conclusion Exposure to ambient NO2 is associated with increased risks of both SGA and LGA, and the most susceptible weekly exposure windows are nested within the 12 weeks before pregnancy and early pregnancy.

Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes

ABSTRACT Objective: To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Materials and methods: Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. Results: A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Conclusions: Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.

Maternal and neonatal complications in macrosomic pregnancies

 Background: Fetal macrosomia is a common problem in obstetrics which leads to morbidity and mortality to both mothers as well as to the new-born due to complications of fetal macrosomia like prolonged labour, operative delivery, postpartum haemorrhage, perineal trauma, shoulder dystocia, birth trauma, perinatal asphyxia and perinatal mortality. This prospective study was conducted on fetal macrosomia to help future identification of such pregnancies, anticipate complications and to plan proper management.Methods: Maternal, fetal and neonatal consequences of macrosomia with specific attention to etiology of macrosomia in 170 pregnant women having gestational age of 37 weeks or more and high risk of fetal macrosomia were studied. Clinical estimation of fetal body weight was done using Leopold’s maneuvers and patient then referred for ultrasonography.  Data was collected about mode of delivery, nature and severity of birth trauma.Results: It was found that maternal age (51.76%), multiparity (61.76%), maternal diabetes (20.59 %) was significantly associated with macrosomia. Total caesarean rate in macrosomia was 26.4%. We got only 8 cases of birth trauma out of 170 macrosomic births.Conclusions: Pregnancies complicated by fetal macrosomia can be best managed by giving a trial of labour for babies with fetal weight below 5000 gram. Post gestation, multiparity found to be main risk factor for macrosomia.

Profile of pregnant women with gestational diabetes mellitus at increased risk for large for gestational age newborns / Perfil de gestantes com diabetes mellitus gestacional com maior risco para recém-nascidos grandes para a idade gestacional

Abstract Objective Gestational diabetes mellitus (GDM) is associated with a higher risk of perinatal morbidity and mortality, and its main complication is the occurrence of large for gestational age (LGA) newborns. The present study aims to characterize pregnant women with GDM and to identify factors associated with the occurrence of LGA newborns in this population. Methods A cross-sectional study was performed based on medical records of women whose prenatal care and delivery were performed at the Maternal and Child Unit of the HospitalUniversitário of theUniversidade Federal doMaranhão, state of Maranhão, Brazil.A total of 116 pregnant women diagnosed with GDMwere included according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Results The variables associated with LGA newborns after multivariate analysis were: obesity prior to pregnancy (OR = 11.6; 95% CI: 1.40-95.9), previous macrosomia (OR = 34.7; 95% CI: 4.08-295.3), high blood glucose levels in the 3rd trimester (OR = 2,67; 95% CI: 1.01-7.12) and combined change in the oral glucose tolerance test (OGTT) (fasting + postdextrose) (OR = 3.53;95%CI:1.25-14.2) = 1.17-10.6).Otherwise, insufficientweight gain during pregnancy reduced the risk for LGA newborns (OR = 0.04; 95% CI: 0.01-0.32). Conclusion Obesity prior to pregnancy, previous macrosomia, high blood glucose levels in the 3rd trimester, and combined change in the OGTT were independent predictive factors for LGA newborns in pregnant women with GDM.

Resumo Objetivo Diabetes mellitus gestacional (DMG) está associado a um maior risco de morbidade e mortalidade perinatais, e sua principal complicação é a ocorrência de recém-nascidos grandes para idade gestacional (GIG). O presente estudo visa caracterizar as gestantes com DMG e identificar fatores associados à ocorrência de recémnascidos GIG nesta população. Métodos Estudo transversal realizado a partir da coleta de dados de prontuário de mulheres cujo acompanhamento pré-natal e parto foram realizados na Unidade Materno-Infantil do Hospital Universitário da Universidade Federal do Maranhão, MA, Brasil. Foram incluídas 116 gestantes diagnosticadas com DMG pelo critério do International Association of Diabetes and Pregnancy Study Groups (IADPSG). Resultados As variáveis associadas à GIG após análise multivariada foram: obesidade pré-gestacional (OR= 11,6; IC 95%: 1,40-95,9), macrossomia anterior (OR = 34,7; IC 95%: 4,08-295,3), glicemia em jejum elevada no 3° trimestre (OR = 2,67; IC 95%: 1,01-7,12) e alteração combinada no teste de tolerância oral à glicose (jejum + pósdextrose) (OR= 3,53; IC 95%: 1,17-10,6). Ganho de peso inferior reduziu o risco para GIG (OR= 0,04; IC 95%: 0,01-0,32). Conclusão Obesidade anterior à gestação, macrossomia prévia, níveis elevados de glicose no sangue no 3° trimestre e alteração combinada no TOTG foram fatores preditivos independentes para os recém-nascidos GIG em gestantes com DMG.

Association and interaction of pre-pregnant body mass index and gestational weight gain of women on neonatal birthweight / 中华流行病学杂志

Objective To investigate the association between maternal pre-pregnant body mass index and gestational weight gain,as well as their interaction on neonatal birthweight.Methods We built a cohort in Anqing Municipal Hospital from January 2014 to March 2015,enrolling pregnant women who decided to give birth in this hospital.All women were asked to fill a questionnaire for basic information collection.Medical information of both pregnant women and their newborns were obtained through electronic medical record.Chi-square analysis,multinomial logistic regression,multiplicative and additive interaction methods were used to analyze the association between prepregnant body mass index and gestational weight gain as well as their interactions on birth weight of the neonates.Results A total of 2 881 pregnant women were included in this study.Of the 2 881 newborns,359 (12.46％) were small for gestational age (SGA) and 273 (9.48％) were large for gestational age (LGA).After adjusting the possible confounding factors,results from the multinomial logistic regression showed that pre-pregnancy underweight women were more possible to deliver SGA (aRR=1.33,95％CI:1.02-1.73).If the gestational weight gain was below the recommended criteria,the risk of SGA (aRR=1.64,95％ CI:1.23-2.19) might increase.Pre-pregnancy overweight/obese could increase the risk of being LGA (aRR=1.86,95％ CI:1.33-2.60).Maternal gestational weight gain above the recommendation level was associated with higher rates of LGA (aRR=2.03,95％CI:1.49-2.78).Results from the interaction analysis showed that there appeared no significant interaction between pre-pregnancy BMI and gestational weight on birthweight.Conclusion Pre-pregnancy body mass index and gestational weight gain were independently associated with neonatal birthweight while pre-pregnancy BMI and gestational weight gain did not present interaction on birthweight.

The relationship of maternal and umbilical cord blood zinc level associated with newborn birth weight: a birth cohort study / 中华预防医学杂志

Objective@#To study serum zinc level in pregnancy and umbilical cord blood and their association with newborn birth weight.@*Methods@#Pregnant women accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014. The follow up was conducted during their first, second and third trimesters of pregnancy and the self-designed questionnaire was used to collect information of social and demographic characteristics. Blood samples in the first, second pregnancy period and umbilical cord blood samples were collected and serum concentrations of zinc were assayed. 3 239 mother-infant entered the final analysis. We divided serum zinc level into low (<P25), medium (P25-P75) and high (>P75) groups according to their exposure concentrations at each trimesters. Non-conditional multivariate logistic regression model was conducted to evaluate the association between serum zinc level in first, second trimesters of pregnancy and umbilical cord blood with small for gestational age (SGA) and large for gestational age (LGA).@*Results@#Serum zinc level in P50 (P25-P75) during the first, second trimesters and cord blood were 1 016.18 (907.09-1 145.60), 813.36 (732.47-897.89) and 903.44 (808.71-1 015.64) μg/L, respectively. The prevalence of zinc deficiency during the first, second trimesters and cord blood were 1.5% (44/2 957), 15.9% (492/3 087) and 6.5% (176/2 707), respectively. The prevalence of total SGA and LGA were 9.7% (313/3 239) and 16.5% (536/3 239), respectively. Compared to high-level serum zinc group, the risk of SGA (OR (95%CI) in low-level serum zinc group during first trimesters was 1.51 (1.05-2.19)). Serum zinc level among second pregnancy period and umbilical cord blood had no statistically significant effect on SGA and LGA (both P values >0.05).@*Conclusion@#Zinc nutritional status of pregnant women in Ma'anshan city was at a good level. The low serum zinc level in first trimester increased the risk of SGA.

Association and interaction of pre-pregnant body mass index and gestational weight gain of women on neonatal birthweight / 中华流行病学杂志

Objective To investigate the association between maternal pre-pregnant body mass index and gestational weight gain,as well as their interaction on neonatal birthweight.Methods We built a cohort in Anqing Municipal Hospital from January 2014 to March 2015,enrolling pregnant women who decided to give birth in this hospital.All women were asked to fill a questionnaire for basic information collection.Medical information of both pregnant women and their newborns were obtained through electronic medical record.Chi-square analysis,multinomial logistic regression,multiplicative and additive interaction methods were used to analyze the association between prepregnant body mass index and gestational weight gain as well as their interactions on birth weight of the neonates.Results A total of 2 881 pregnant women were included in this study.Of the 2 881 newborns,359 (12.46％) were small for gestational age (SGA) and 273 (9.48％) were large for gestational age (LGA).After adjusting the possible confounding factors,results from the multinomial logistic regression showed that pre-pregnancy underweight women were more possible to deliver SGA (aRR=1.33,95％CI:1.02-1.73).If the gestational weight gain was below the recommended criteria,the risk of SGA (aRR=1.64,95％ CI:1.23-2.19) might increase.Pre-pregnancy overweight/obese could increase the risk of being LGA (aRR=1.86,95％ CI:1.33-2.60).Maternal gestational weight gain above the recommendation level was associated with higher rates of LGA (aRR=2.03,95％CI:1.49-2.78).Results from the interaction analysis showed that there appeared no significant interaction between pre-pregnancy BMI and gestational weight on birthweight.Conclusion Pre-pregnancy body mass index and gestational weight gain were independently associated with neonatal birthweight while pre-pregnancy BMI and gestational weight gain did not present interaction on birthweight.

Relationship between Neonatal Umbilical Cord Blood Irisin Level and Birth Weight and Intrauterine Growth Restriction / 医学研究杂志

Objective SGA and IURG fetuses are important risk factors for metabolic disease in adulthood,but the mechanism is not clear.In this study,Irisin levels in umbilical cord blood of different birth weight and IURG neonates were measured and the relationship between Irisin and neonatal weight,gestational age and other factors was explored.Methods This study was conducted in the cross-sectional study of neonates born in our hospital from 2014 to 2016.Newborns were divided into small-for-gestational age (SGA),greater-than-gestational age (LGA),gestational age (AGA) and newborns with intrauterine growth restriction (IUGR).The levels of irisin in umbilical cord blood of 4 newborns were detected.Results In this study,there were a total of 110 cases of newborns.The mean gestational age and mean birth weight of newborns in the SGA group was lower than that in the other three groups(P =0.000).The mean Irisin levels in the SGA and IUGR groups [54.4(45.6-66.7) ng/ml,53.7 (40.3-62.4) ng/ml] were significantly lower than those in the AGA group [67.7 (53.8-78.1) ng/ml,64.7 (53.6-71.2) ng/ml] (P =0.000).The mean insulin levels in the LGA group [7.54(0.83-58.96)mIU/ml] were significantly higher than those in the AGA group [38.00(34.40-39.30)mIU/ml] and IU-GR [3.86(0.49-16.15)] and SGA [4.19 (0.62-14.42)mIU/ml] (P =0.000).In the present study,the correlation analysis showed that Irisin level in neonatal umbilical cord blood was significantly correlated with neonatal gestational age (r =0.22,P ＜ 0.01),fetal weight (r =0.17,P ＜0.01) and maternal age (r =-0.12,P =0.021).However,only in the LGA group,the level of Irisin in cord blood of neonates was positively correlated with insulin level (r =0.41,P =0.042).Multivariate linear regression analysis revealed that SGA (β =-0.14,P =0.02) and fetal weight (β =0.05,P =0.008) were independent risk factors for neonatal umbilical cord blood Irisin levels.Conclusion There was a positive correlation between irisin level and neonatal umbilical cord blood birth weight.The levels of irisin in the neonates of the SGA and IURG groups were significantly lower than those of the AGA and LGA groups,but irisin levels did not differ between the SGA and IURG groups and between AGA and LGA groups.And irisin levels in the LGA group were positively correlated with insulin levels.Our results also reveal that singleton infants of mothers with preeclampsia had lower cord blood irisin levels compared to infants of mothers without preeclampsia.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus

ABSTRACT Objective Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Prediction and Prevention of Large for Gestational Age in Gestational Diabetes Mellitus / 대한주산의학회잡지

Gestational diabetes mellitus (GDM) is an important disease which complicates pregnant woman and fetus. Large for gestational age (LGA) is one of the primary complications and is closely associated with the hyperglycemia of pregnant woman. Although strict control of blood glucose can decrease the occurrence of LGA, the rate of LGA in GDM pregnancy is higher than that of normal pregnancy. Understanding of the difference of fetal growth between LGA and adequate for gestational age in GDM pregnancy and consideration about the time and marker for prediction and prevention of LGA in GDM pregnancy are helpful for prenatal care of GDM pregnancy. In this article, the prediction and prevention of LGA in GDM pregnancy will be discussed.

Birth weight classification in gestational diabetes: is there an ideal chart?

Introduction: Gestational diabetes mellitus (GDM) is associated to increased rates of large for gestational age (LGA) newborns and macrosomia. Several charts are used to classify birth weight. Is there an ideal chart to classify newborns of GDM mothers? Methods: We evaluated adequacy of birth weight of 332 neonates born to GDM mothers at Hospital de Clínicas de Porto Alegre, Brazil. Newborns were classified according to gestational age as small (SGA), adequate, or large (LGA) based on four charts: Alexander, Pedreira, INTERGROWTH 21st Project, and SINASC-2012. The latter was built using data from a large national registry of 2012, the Born Alive National Surveillance System (Sistema de Informações de Nascidos Vivos ­ SINASC), which included 2,905.789 birth certificates. Frequencies of SGA and LGA and Kappa agreement were calculated. Results: In non-gender adjusted curves, SGA rates (95% confidence interval) varied from 8% (5-11) to 9% (6-13); LGA rates, from 11% (8-15) to 17% (13-21). For males, SGA rates varied from 3% (1-6%) to 6% (3-11%), and LGA rates, from 18% (13-24%) to 31% (24-38%); for females, SGA rates were from 3% (1-7%) to 10% (6-16%) and LGA rates, from 11% (6-16%) to 19% (13-26%). Kappa results were: ALEXANDER vs. SINASC-2012: 0.80 (0.73-0.88); INTERGROWTH 21st vs. SINASC-2012 (adjusted by sex): 0.62 (0.53-0.71); INTERGROWTH 21st vs. PEDREIRA: 0.71 (0.62-0.79); SINASC-2012 (by sex) vs. PEDREIRA: 0.86 (0.79-0.93). Conclusions: Misclassification has to be taken into account when evaluating newborns of GDM mothers, as LGA rates can almost double depending on the chart used to classify birth weight (AU)

Glucose level of oral glucose tolerance test is associated with the occurrence of large for gestational age infants / 中华内分泌代谢杂志

To explore the influence of glucose level of 75 g oral glucose tolerance test ( OGTT ) druing pregnancy on delivery of large for gestational age infants. This research selected 790 cases of patients diagnosed as gestational diabetes mellitus( GDM) , 478 cases of pregnant women diagnosed as normal glucose tolerance( NGT) from Affiliated Hospital of Jining Medical University in 2014 and followed up until they delivered. Single live births were selected, risk factors which had influence on offsprings, birth weight were analysed. GDM group had significantly higher rate of delivering large for gestational age(LGA)infants than that of NGT group(47. 30% vs 31. 30%, P<0. 05). Adjusting for confounding factors, it suggested that 2 h plasma glucose level of 75 g OGTT was an independent risk factor for the delivery of LGA infants, and 1 mmol/L glucose increment in 75 g OGTT 2 h plasma glucose level, mayincreasetheriskofLGAby29%(OR=1.29,95%CI1.05-1.58,P=0.02). The2hplasmaglucoselevelof75 g OGTT is an independent risk factor for delivery of LGA infants.

Endocrine and metabolic consequences of being born small- or large-for-gestational age: a review

In this review article, the genetics of size at birth, prenatal metabolic programming and the endocrine and metabolic consequences of abnormal size at birth are discussed. In addition, the relevance of fetal origin of adult disease in developing countries and the public health implication as well as future perspectives are also discussed. Being born either small- or large-for-gestational age affects such children and adults in several ways. These include increased risk of type 2 diabetes mellitus, metabolic syndrome, oxidative stress, persistent reduction in growth, cardiovascular disease, osteoporosis and premature pubarche as well as adrenarche. Individuals with abnormal size at birth who experienced rapid growth in the first three years of life have the greatest risk for future metabolic abnormalities. The mechanisms involved in prenatal (fetal) metabolic programming in infants with abnormal size at birth are just beginning to be explored. Both the “thrifty genes” and the “thrifty phenotype” could result in adverse health consequences later in life on exposure to plentiful nutrition. The most important epigenetic reactions affecting genetic transcription are acetylation and methylation. However, the major challenge at this point in time is to link such alterations with modifications in gene expression and ultimately, with metabolic abnormalities encountered in adult life. Thus, developmental origins of health and disease (DOHaD) represent a relatively new frontier of research and with time, some of the discrepancies may be resolved.

Diabetes e gestação: perfil clínico e laboratorial em pré-natal de alto risco / Diabetes and pregnancy: clinical profile in high-risk prenatal care

Introdução: O diabetes é complicação clínica frequente na gestação e sua prevalência vem aumentando nos últimos anos. Objetivo: Analisar a frequência dos tipos de diabetes na gestação, as características clínicas das gestantes e alguns desfechos materno-fetais, em pré-natal de alto risco. Método: Estudo retrospectivo de revisão dos prontuários eletrônicos de mulheres com diabetes e gestação atendidas no período de janeiro 2009 a junho 2010 no Hospital de Clínicas de Porto Alegre (HCPA). Resultados: Nesse período, 173 gestantes foram atendidas no ambulatório de gestação e diabetes, no total de 1459 consultas. O diabetes gestacional ocorreu em 84% das gestantes, 8% apresentaram diabetes tipo 2, 6%, diabetes tipo 1 e 2%, outros tipos. As mulheres com diabetes gestacional apresentaram HbA1c inferior às demais. A maioria das pacientes iniciou o pré-natal após o primeiro trimestre. A taxa geral de cesariana foi de 56%, tendo sido mais frequente no diabetes tipo 1. O recém-nascido foi considerado pequeno para a idade gestacional em 9% dos casos, e grande em 13%, sem diferença entre os tipos de diabetes. Nas mulheres com diabetes gestacional, o peso do recém-nascido correlacionou-se positivamente com o índice de massa corporal, glicemia de jejum ao diagnóstico e HbA1c da mãe. Conclusão: O diabetes associado à gestação é motivo frequente de atendimento no pré-natal especializado do HCPA, sendo a maioria diabetes gestacional. Nesses casos, obesidade e pior controle glicêmico associaram-se com o peso fetal aumentado. As gestantes chegam tardiamente ao centro de tratamento, com controle metabólico aquém do recomendado.

Background: Gestational diabetes is a common complication of pregnancy and its prevalence has increased in the last years. Aim: To describe the frequency of different types of diabetes, maternal clinical characteristics, and pregnancy outcomes in pregnant diabetic women who received prenatal care at a high-risk prenatal center. Method: Review of medical records of pregnant diabetic women who received prenatal care between January 2009 and June 2010 at Hospital de Clínicas de Porto Alegre (HCPA). Results: In this period, 173 pregnant diabetic women received prenatal care; 1,459 medical visits were made. Gestational diabetes was diagnosed in 84% of the women, 8% had type 2 diabetes, 6% had type 1 diabetes, and 2% had other types of diabetes. Women with gestational diabetes had lower HbA1c than the other diabetic groups. Most patients started the prenatal care after the first quarter. The global frequency of cesarean section was 56% but it was more frequent among type 1 diabetics. Newborns were small for gestational age in 9% of the cases and large for gestational age in 13%, without significant differences between different types of diabetes. In gestational diabetic women, birth weight was associated with mother’s body mass index, fasting glycemia at diagnosis, and HbA1c. Conclusion: Diabetes associated with pregnancy is a frequent reason for prenatal care at HCPA; gestational diabetes is the most frequent type of diabetes and, in these women, maternal obesity and worst glycemic control adversely influenced fetal birth weight. Patients arrive with a suboptimal glycemic control and start their treatment with undesirable delay.

Complications and Perinatal Factors According to the Birth Weight Groups in the Infants of Diabetic Mothers

PURPOSE: This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). METHODS: Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. RESULTS: Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. CONCLUSION: In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.

The Study of Hypoglycemia in Fullterm with Large for Gestational Age Newborns

PURPOSE: This study is to determine the frequency, onset age, and the proper duration of evaluation in fullterm large for gestational age (LGA) newborn infant. We also compared risk factors between hypoglycemic and euglycemic newborns. METHODS: 77 term newborns from non-diabetic mothers who were greater than 90 percentile on Lubchencho growth curves were included in this study. Blood glucose levels were checked at age 1, 2, 3, 6, 12, 24, 36, 72, 96 hours and cord blood with rapid strip test. Hypoglycemia was defined as a serum glucose less than 35 mg/dL at less than 3 hours, less than 40 mg/dL between 3 to 24 hours, and less than 45 mg/dL at greater than 24 hours of age. RESULTS: In 77 fullterm neonates with LGA (4,185+/-224 g, 39+/-0.9 wk), frequency of hypoglycemia was 9 case (11.7%) and 3 case of them (3.9%) had clinical symptoms of hypoglycemia. The mean onset age and mean serum glucose level were 2.56+/-2.13 hour and 34+/-6 mg/dL. Glucose level started to decrease in 1 hour and showed lowest at 2 hours. No hypoglycemic patients were noticed after 6 hours of life. There were no significant differences in delivery type, sex, preeclampsia and meconium staining between hypoglycemic and euglycemic newborns except maternal body weight greater than 80 kg (P<0.05). CONCLUSION: Screening of hypoglycemia after 6 hours of age in fullterm LGA newborn infants might not be necessary. And neonatal hypoglycemia should be considered if maternal body weight greater than 80 kg.

Early prediction of birth weight percentile and large for gestational age fetuses using gestation-adjusted projection of estimated fetal weight / 대한산부인과학회잡지

OBJECTIVE: To evaluate the accuracy of predicted birth weight percentile and large for gestational age(LGA) fetuses by the gestation-adjusted projection method using estimated fetal weight. METHODS: From 462 low-risk pregnancies with singleton fetus, fetal biometry including fetal biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC), and femur length(FL) was made from 30 weeks of gestation until term. Estimated fetal weight(EFW) by combinations of fetal biometry were made by Campbell, Hadlock1, Hadlock2, and Shepard formulas respectively. The diagnostic accuracy according to 4 formulas was assessed by correlation between EFW percentile and birth weight percentile, prediction of LGA fetuses, and prediction error(percentile difference between birth weight and EFW). RESULTS: The mean gestational age on ultrasound and on birth, and birth weight were 33.21 +/- 2.08(30-40) weeks, 38.43 +/- 1.72(30-42) weeks, and 3.14 +/- 0.47(0.99-4.38) Kg, respectively. The diagnostic accuracies of gestation-projection method using EFW were similar result to predict birth weight percentile and LGA fetuses according to 4 formulas. Correlation between EFW percentile and birth weight percentile(correlation coefficient, r) were Campbell: 0.644(p <0.001), Hadlock 1: 0.682(p <0.001), Hadlock 2: 0.681(p <0.001), Shepard: 0.638(p <0.001), respectively. Youden's index(sensitivity + specificity - 1) in prediction of LGA fetuses were Campbell: 0.532, Hadlock1: 0.525, Hadlock2: 0.520, Shepard: 0.549, respectively. Prediction error were Campbell: 18.14+/-16.56, Hadlock1: 16.19+/-14.35, Hadlock2: 16.10+/-14.29, Shepard: 19.68+/-17.00, respectively. The prediction error was increased according to increasing of lapse time(p <0.001), gestational weeks on ultrasound, and estimated fetal weight percentile, and decreasing birth weight percentile(p <0.001)(R square=0.411, (p <0.001). But, amniotic fluid index did not affect to prediction error(p=0.199). CONCLUSION: Our study presented relatively accurate prediction for birth weight percentile and LGA fetuses from remote sonographic examination. If LGA fetuses was suspected by antenatal ultrasound, adequate therapy and periodic observation are recommended for good perinatal outcome.

The effect of Large for Gestational Age on Asymmetrical Ventricular Septal Hypertrophy in the Newborn

PURPOSE: It has been known for a long time that infants of insulin dependent diabetic mothers are prone to develop macrosornia, organomegaly, hyperbilirubinemia, respiratory distress syndrome, hypoglycemia, hypocalcemia, septicemia and congenital anomalies in the neonatal period. And echocardiographic asymmetrical- ventricular septal hyper- trophy(ASH) has been observed in the newborn infants of diabetic mothers. The etiology of the ASH remains unknown, although fetal hyperglycemia and subsequent glycogen deposits have been postulated as contributing factors. Therefore, we have studied whether large for gestational age(LGA) has played an important role of developing ASH. METHODS: We compared echocardiographic findings in neonates of LGA and appro- priate for gestational age(AGA), who were admitted to the Department of Pediatrics, Chung Ang University Hospital from April 1994 to March 1997. RESULTS: 1) Mean LVED in LGA and AGA were 1.96+0.06cm and 1.94+0.04cm, respectively. 2) Mean LVPW in LGA and AGA were 0.37+0.05cm and 0.370.05cm, respectively. 3) Mean IVS in LGA and AGA were 0.400.09cm and 0.380.09cm, respectively. 4) Mean IVS/ LVPW in LGA and AGA were 1.09+0.12 and 1.040.17, respectively. There was no statistical significance between two groups in echocardiographic findings. CONCLUSION: There is no relation between LGA and ASH in the neonate. According- ly, we may not need to perform echocardiography LGA routinely.