[Neuropsychological development of large for gestational age infants at the age of 12 months]. / 大于胎龄儿12æœˆé¾„ç¥žç»å¿ƒç†å‘è‚²çŠ¶å†µç ”ç©¶.

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.

Impact of experiencing multiple vulnerabilities on fetal growth and complications in women with hyperglycemia in pregnancy.

BACKGROUND: In women with hyperglycemia in pregnancy living in France, psychosocial deprivation is associated with both earlier and greater exposure to the condition, as well as poorer maternofetal prognosis. We explored the impact of this and two other socioeconomic vulnerability indicators-food insecurity and poor language proficiency-on adherence to prenatal care and maternal and fetal outcomes. METHODS: In a socially deprived suburb of Paris, we selected women who delivered between 01/01/2012 and 31/12/2018 and received care (nurse, dietician, diabetologist evaluation, advice, regular follow-up to adjust insulin doses if requested) for hyperglycemia in pregnancy. We analyzed the associations between individual psychosocial deprivation, food insecurity, French language proficiency (variables assessed by individual questionnaires) and fetal growth (main outcome), as well as other core maternal and fetal outcomes. RESULTS: Among the 1,168 women included (multiethnic cohort, 19.3% of whom were Europeans), 56%, 17.9%, and 27.5% had psychosocial deprivation, food insecurity, and poor French language proficiency, respectively. Forty-three percent were prescribed insulin therapy. Women with more than one vulnerability had more consultations for diabetes. The rates for small (SGA), appropriate (AGA), and large-for-gestational-age (LGA) infant were 11.4%, 76.5% and 12.2%, respectively. These rates were similar in women with and without psychosocial deprivation, and in those with and without food insecurity. Interestingly, women with poor French language proficiency had a higher odds ratio of delivering a small- or large-for-gestational age infant than those with good proficiency. CONCLUSION: We found similar pregnancy outcomes for women with hyperglycemia in pregnancy living in France, irrespective of whether or not they had psychosocial deprivation or food insecurity. Optimized single-center care with specialized follow-up could contribute to reduce inequalities in maternal and fetal outcomes in women with hyperglycemia in pregnancy.

Glycemic status during pregnancy according to fasting and post-load glucose values: The association with adverse pregnancy outcomes. An observational study.

AIM: Prognosis of treated hyperglycemia in pregnancy (HIP) may differ according to whether diagnosis following an oral glucose tolerance test (OGTT) is based on high fasting and/or high post-load glucose values. METHODS: From a multiethnic prospective study, we included 8,339 women screened for HIP after 22 weeks of gestation. We evaluated the risk of large-for-gestational-age (LGA) infant (primary endpoint) and other adverse pregnancy outcomes according to HIP status in four groups defined as follows: no HIP (n = 6,832, reference); isolated fasting HIP (n = 465), isolated post-load HIP (n = 646), and fasting and post-load HIP (n = 396). RESULTS: After adjusting for age, body mass index, ethnicity, smoking during pregnancy and parity, compared with no HIP, the adjusted odds ratios [95% confidence interval] for LGA infant were higher in the isolated fasting HIP (1.47 [1.11-1.96]) and fasting and post-load HIP (1.65 [1.23-2.21]) groups, but not in the isolated post-load HIP (1.13 [0.86-1.48]) group. The adjusted odds ratios for preterm delivery and neonatal intensive care unit were higher in the post-load HIP group (1.44 [1.03-2.03] and 1.28 [1.04-1.57], respectively), the fasting and post-load HIP group (1.81 [1.23-2.68] and 1.42 [1.10-1.81], respectively) but not in the isolated fasting HIP group (1.34 [0.90-2.00] and 1.20 [0.94-1.52], respectively). CONCLUSION: Despite glucose-lowering care and adjustment for confounders, compared with no HIP, fasting HIP was associated with a higher rate of LGA infant, whereas post-load HIP was associated with higher preterm delivery and neonatal intensive care unit admission rates.

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.

The Predictive Ability of Hepatic Steatosis Index for Gestational Diabetes Mellitus and Large for Gestational Age Infant Compared with Other Noninvasive Indices Among Chinese Pregnancies: A Preliminary Double-center Cohort Study.

OBJECTIVE: To evaluate the association of hepatic steatosis index (HSI) in the first trimester and the risk of gestational diabetes mellitus (GDM) as well as large for gestational age (LGA) infant in Chinese women. METHODS: A total of 1082 pregnant women were included in this study. Maternal basic laboratory data, including ALT, AST, FBG, insulin, TG, and HDL-C, were tested during 6-12 weeks of gestation and anthropometric characteristics were monitored during gestation. A 75-g oral glucose tolerance test (OGTT) was conducted at 24-28 weeks of gestation. HSI, nonalcoholic fatty liver disease (NAFLD) liver fat score, triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) and triglyceride-glucose (TyG) index were calculated. Odds ratio with 95% confidence interval for subsequent risk of GDM and LGA by HSI quartiles were assessed by binary logistic regression model. The predictive ability of HSI for GDM and LGA was evaluated by the receiver operating characteristic (ROC) curve analysis and was compared with other indices. RESULTS: The incidence of GDM and LGA were 22.09% (239/1082) and 10.53% (87/826). HSI was higher in GDM group than in NGT group (median, interquartile range: 30.67, 27.20-35.10 vs 27.98, 25.70-30.82, P<0.001). Incidence of GDM was gradually increased with increasing HSI values. Women in the highest HSI quartile had significantly higher risk of LGA delivery than those in the lowest HSI quartile (P<0.05). The area under the ROC curves of HSI for GDM and LGA were higher than other indices, reaching 0.646 (95%CI: 0.605-0.686) and 0.600 (95%CI: 0.541-0.660), respectively. CONCLUSION: Higher HSI was independently associated with higher risk of GDM and LGA in Chinese women. HSI in the first trimester can predict the risk of GDM and LGA.

The Predictive Ability of Two Triglyceride-Associated Indices for Gestational Diabetes Mellitus and Large for Gestational Age Infant Among Chinese Pregnancies: A Preliminary Cohort Study.

BACKGROUND/AIMS: To investigate the potential of maternal first-trimester triglyceride (TG) to high-density lipoprotein cholesterol (TG/HDL-c) ratio, triglyceride glucose index (TyG) and total cholesterol (TC)/HDL-c to predict the risk of later gestational diabetes mellitus (GDM) and large for gestational age (LGA) newborn in Chinese women. METHODS: We included 352 women with a singleton pregnancy, who were followed up prospectively from the first prenatal visit until delivery. Fasting glucose and plasma lipid profiles including TG, TC, HDL-c, and low-density lipoprotein cholesterol (LDL-c) were measured in the first trimester. A binary logistic regression analysis was performed to determine the odds ratios (ORs) and 95% confidence intervals (CIs) of GDM and LGA according to tertiles of those indices, respectively. Receiver-operating characteristic curve (ROC) and areas under the curve (AUC) were employed to evaluate the ability of those indices to predict the risk of GDM and LGA infants, and differences in the AUC values between them were compared. RESULTS: Women with the top tertile of TG/HDL-c or TyG other than TC/HDL-c had a significantly higher risk of GDM (ORTG/HDL-c=2.388, 95% CI 1.026-5.467; ORTyG=3.535, 95% CI 1.483-8.426, respectively) and LGA infant delivery (ORTG/HDL-c=3.742, 95% CI 1.114-12.569; ORTyG=3.011, 95% CI 1.012-8.962, respectively) than women with the lowest tertile of TG/HDL-c or TyG after adjusting for confounders. The AUC of TG/HDL-c and TyG to detect GDM was 0.664 (95% CI 0.595-0.733) and 0.686 (95% CI 0.615-0.756), respectively, and that to detect LGA was 0.646 (95% CI 0.559-0.734) and 0.643 (95% CI 0.552-0.735), respectively (all P < 0.01). There were no statistical differences between TG/HDL-c and TyG in the ability of predicting the risk of GDM or LGA infants. CONCLUSION: Maternal first-trimester TG/HDL-c and TyG are both good indicators in predicting the risk of later GDM and LGA newborn, and it may be useful to evaluate them in early pregnancy.

Are there specific factors associated with prenatally undiagnosed foetal macrosomia?

OBJECTIVE: Fetal macrosomia is known to increase maternal and neonatal complications, but 20%-50% of the macrosomic fetuses are prenatally undiagnosed. Our objective was to identify specific factors associated with undiagnosed fetal macrosomia in women without diabetes. METHODS: Retrospective case-control study in a tertiary maternity unit between January 1st and December 31st, 2016. Inclusion of all women delivering after 37 weeks of a single live-born macrosomic infant, i.e., with a birth weight ≥ 90th percentile for gestational age (GA). Women with pre-existing or gestational diabetes were excluded. To identify specific factors associated with undiagnosed foetal macrosomia, we compared risk factors for macrosomia, maternal characteristics, father's body mass index (BMI) and prenatal follow up between two groups depending on whether macrosomia was prenatally diagnosed or not. RESULTS: Among 428 macrosomic newborns, 224 (52.3 %) were prenatally undiagnosed. Known risk factors for macrosomia, maternal characteristics (such as low socio-economic level, low education level) and father's BMI were similar between the two groups. The prenatal follow up was comparable between the two groups. Ultrasound estimated foetal weight during the 3rd trimester was lower in the undiagnosed macrosomic foetuses compared to diagnosed macrosomic foetuses (2130±279 vs 2445±333, p<0.001). CONCLUSIONS: No specific factor of undiagnosed macrosomia was identified, and women with prenatally undiagnosed fetal macrosomia had the same risk factors than women with diagnosed macrosomia. Our study suggests that our groups have different growth curves. This hypothesis has yet to be studied.

The high maternal TG level at early trimester was associated with the increased risk of LGA newborn in non-obesity pregnant women.

INTRODUCTION: Recent research had shown blood glucose was not the only cause of large for gestational age infant (LGA), the contributions of other fuels such as lipids also play an important role in fetal development. However the association between maternal triglyceride at early trimester and the risk of LGA has not yet been clearly elucidated. This research evaluated the association of maternal early trimester TG level with the risk of LGA infant in Chinese mothers. METHODS: 2839 pregnant women were recruited at the first visit of their perinatal health care and followed up prospectively till after delivery. The demographic, maternal characteristics were extracted from a questionnaire. Infant characteristics were collected at delivery. Maternal fasting serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (HDL-C)levels, were measured in 6~8th, 16th, 24th, and 36th gestational weeks. Fasting serum glucose levels were measured at 6~8th, 24th, and 36th gestational weeks. Logistic regression model was used to calculate the odds ratio (OR) and 95% confidence intervals. RESULTS: A consistently lower TG level was observed in mothers with non-LGA infant than mothers with LGA infant and TG level of mothers of LGA infants increased faster than that of control group. The incidence of LGA infants between two groups (TG<1.7 mmol/L and TG ≥ 1.7 mmol/L) was 14.46 and 26.63%, respectively. Mothers with the highest TG level (TG > 1.19 mmol/L) gave birth to infants with higher birth weight (BW) than the other two groups (TG < 0.70 mmol/L and TG:0.70~0.89 mmol/L). When stratified by pre-pregnancy body mass index (pre-BMI), a significantly positive association was founded between the maternal TG level at early trimester and the risk of LGA in non-overweight/obesity women (OR = 1.740, p = 0.034). CONCLUSIONS: The findings suggested that high maternal TG level at very early trimester was associated with the increased risk of LGA in non-overweight/obesity pregnant women. Moreover, high maternal TG level at first trimester may be an early predictor of LGA.

Determinants of Infant Birthweight / 대한주산의학회잡지

PURPOSE:To examine the association between gestational weight gain pattern and infant birth weight and to analyse the determinant factors for infant birthweight. METHODS: We used data collected from 937 pregnant women delivered without complications in Dankook University Hospital from December 1994 to October 1995. Using multiple regression analysis we investigated the determinant, factors for infant birthweight. RESULTS: The mean pre-pregnancy weight, the mean height and pre-pregnancy body mass index of objects was 52.5 kg, 159 cm and 20.8 kg/m, respectively. The total gestational weight gain was 12.9 kg and the mean infant birthweight was 3,165 g with mean gestational age of 38 weeks. Multiparous mother was older, heavier in pre-pregnancy body weight, higher in pre-pregnancy body mass index than primiparous mother, and shows less gestational weight gain than primiparous mother. According to the IOM guidelines, we classified objects into groups of the Under-gain, the Recommended gain and the Over-gain. The Under-gain groupshows less infant birthweight and had more small-for-gestational age infants than other groups. The Over-gain group had more large-for-gestational age infants than other groups. 'I'he major determinant factors for infant birthweight were gestational age, placental weight, gestational weight gain, pre-pregnancy body mass index, infant sex, parity and maternal height. CONCLUSIONS: The results suggest that we must focus to check the gestational weight gain and the maternal nutritional status to ensure the adequate infant birthweight for prenatal care. To evaluate the infant birthweight, we must consider gestational weight gain, pre -pregnancy body mass index, infant sex, parity and maternal height including gestational age.