Sonographic and other nonglycemic factors can predict large-for-gestational-age infants in diet-managed gestational diabetes mellitus: A retrospective cohort study.
Adult
Birth Weight
Cohort Studies
Diabetes, Gestational
/ diagnosis
Female
Fetal Macrosomia
/ diagnosis
Humans
Infant, Newborn
Maternal Nutritional Physiological Phenomena
Pregnancy
Pregnancy Outcome
/ epidemiology
Prenatal Care
/ methods
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Ultrasonography, Prenatal
Young Adult
diet control
gestational diabetes mellitus
large for gestational age
ultrasound
大于胎龄
妊娠期糖尿病
超声
饮食控制
Journal
Journal of diabetes
ISSN: 1753-0407
Titre abrégé: J Diabetes
Pays: Australia
ID NLM: 101504326
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
01
12
2019
revised:
01
03
2020
accepted:
27
03
2020
pubmed:
7
4
2020
medline:
22
4
2021
entrez:
7
4
2020
Statut:
ppublish
Résumé
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. 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. 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. 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. 背景: 妊娠糖尿病(GDM)是妊娠期最常见的并发症之一。如果不进行治疗或控制不佳, GDM会导致不良的婴儿结局, 如大于胎龄儿(LGA)。这项研究旨在确定饮食管理的GDM, 其LGA结局的非血糖母婴因素。 方法: 这是一项回顾性队列研究,追踪了从2004年到2015年单胎妊娠并进行饮食管理的GDM患者。对产妇和产期因素进行多因素Logistic回归分析, 找出LGA的危险因素。此外, 对妊娠18周到22周、24周到28周和29周到33周有胎儿腹围的超声测量数据进行了亚组单变量分析。 结果: 共纳入1064名妇女, 分娩123名LGA婴儿。产次高(比值比(OR)1.44；CI, 1.23-1.68；P<0.001)和孕前体重指数(BMI)高(OR 1.09；CI, 1.06-1.12；P<0.001)的妇女更有可能分娩LGA婴儿。母亲吸烟(OR 0.30；CI, 0.14-0.62；P=0.001)和出生时较高的胎龄(OR 0.91；CI, 0.84-0.99；P=0.018)与风险降低相关。子集单变量分析显示24-28周和29-33周的胎儿腹围超过75百分位数(OR值分别为5.92和13.74)和第90百分位数(OR值分别为4.57和15.89)后, 对LGA有较高的预测价值。 结论: 产次、吸烟状况、母亲BMI、胎龄和超声胎儿腹围测量被确认为是LGA的有用预测因子。这些预测因子的存在可能会促使对妊娠进行更密切的监测和早期治疗干预, 以改善管理并降低胎儿和产妇不良结局的风险。.
Sections du résumé
BACKGROUND
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
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
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
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.
背景: 妊娠糖尿病(GDM)是妊娠期最常见的并发症之一。如果不进行治疗或控制不佳, GDM会导致不良的婴儿结局, 如大于胎龄儿(LGA)。这项研究旨在确定饮食管理的GDM, 其LGA结局的非血糖母婴因素。 方法: 这是一项回顾性队列研究,追踪了从2004年到2015年单胎妊娠并进行饮食管理的GDM患者。对产妇和产期因素进行多因素Logistic回归分析, 找出LGA的危险因素。此外, 对妊娠18周到22周、24周到28周和29周到33周有胎儿腹围的超声测量数据进行了亚组单变量分析。 结果: 共纳入1064名妇女, 分娩123名LGA婴儿。产次高(比值比(OR)1.44；CI, 1.23-1.68；P<0.001)和孕前体重指数(BMI)高(OR 1.09；CI, 1.06-1.12；P<0.001)的妇女更有可能分娩LGA婴儿。母亲吸烟(OR 0.30；CI, 0.14-0.62；P=0.001)和出生时较高的胎龄(OR 0.91；CI, 0.84-0.99；P=0.018)与风险降低相关。子集单变量分析显示24-28周和29-33周的胎儿腹围超过75百分位数(OR值分别为5.92和13.74)和第90百分位数(OR值分别为4.57和15.89)后, 对LGA有较高的预测价值。 结论: 产次、吸烟状况、母亲BMI、胎龄和超声胎儿腹围测量被确认为是LGA的有用预测因子。这些预测因子的存在可能会促使对妊娠进行更密切的监测和早期治疗干预, 以改善管理并降低胎儿和产妇不良结局的风险。.
Autres résumés
Type: Publisher
(chi)
背景: 妊娠糖尿病(GDM)是妊娠期最常见的并发症之一。如果不进行治疗或控制不佳, GDM会导致不良的婴儿结局, 如大于胎龄儿(LGA)。这项研究旨在确定饮食管理的GDM, 其LGA结局的非血糖母婴因素。 方法: 这是一项回顾性队列研究,追踪了从2004年到2015年单胎妊娠并进行饮食管理的GDM患者。对产妇和产期因素进行多因素Logistic回归分析, 找出LGA的危险因素。此外, 对妊娠18周到22周、24周到28周和29周到33周有胎儿腹围的超声测量数据进行了亚组单变量分析。 结果: 共纳入1064名妇女, 分娩123名LGA婴儿。产次高(比值比(OR)1.44；CI, 1.23-1.68；P<0.001)和孕前体重指数(BMI)高(OR 1.09；CI, 1.06-1.12；P<0.001)的妇女更有可能分娩LGA婴儿。母亲吸烟(OR 0.30；CI, 0.14-0.62；P=0.001)和出生时较高的胎龄(OR 0.91；CI, 0.84-0.99；P=0.018)与风险降低相关。子集单变量分析显示24-28周和29-33周的胎儿腹围超过75百分位数(OR值分别为5.92和13.74)和第90百分位数(OR值分别为4.57和15.89)后, 对LGA有较高的预测价值。 结论: 产次、吸烟状况、母亲BMI、胎龄和超声胎儿腹围测量被确认为是LGA的有用预测因子。这些预测因子的存在可能会促使对妊娠进行更密切的监测和早期治疗干预, 以改善管理并降低胎儿和产妇不良结局的风险。.
Identifiants
pubmed: 32250016
doi: 10.1111/1753-0407.13042
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
562-572Informations de copyright
© 2020 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Références
Lorenc A, Otto-Buczkowska E. Maternal diabetes mellitus - risk factor for fetus and infant. J Endocrinol Diabetes. 2018;5(3):1-7.
Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339-1348.
Horvath K, Koch K, Jeitler K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. Br MedJ. 2010;340:c1395.
Falavigna M, Schmidt MI, Trujillo J, et al. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes Res Clin Pract. 2012;98(3):396-405.
Lee K-H, Han Y-J, Chung J-H, et al. Treatment of gestational diabetes diagnosed by the IADPSG criteria decreases excessive fetal growth. Obstet Gynecol Sci. 2020;63(1):19-26.
Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-2486.
Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag. 2009;5(1):153-164.
Zito G, Della Corte L, Giampaolino P, et al. Gestational diabetes mellitus: prevention, diagnosis and treatment. A fresh look to a busy corner. J Neonatal Perinatal Med. 2019;28:1-13. https://doi.org/10.3233/NPM-190305. [Epub ahead of print].
Nolan CJ. Controversies in gestational diabetes. Best Pract Res Clin Obstet Gynaecol. 2011;25(1):37-49.
Pertot T, Molyneaux L, Tan K, Ross GP, Yue DK, Wong J. Can common clinical parameters be used to identify patients who will need insulin treatment in gestational diabetes mellitus? Diabetes Care. 2011;34(10):2214-2216.
Kerényi Z, Tamás G, Kivimäki M, et al. Maternal glycemia and risk of large-for-gestational-age babies in a population-based screening. Diabetes Care. 2009;32(12):2200-2205.
Gomes D, von Kries R, Delius M, et al. Late-pregnancy dysglycemia in obese pregnancies after negative testing for gestational diabetes and risk of future childhood overweight: an interim analysis from a longitudinal mother-child cohort study. PLoS Med. 2018;15(10):e1002681.
Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-786.
Martinez-Frias ML, Frias JP, Bermejo E, Rodriguez-Pinilla E, Prieto L, Frias JL. Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes. Diabet Med. 2005;22(6):775-781.
Moore LL, Singer MR, Bradlee ML, Rothman KJ, Milunsky A. A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology. 2000;11(6):689-694.
Uebel K, Pusch K, Gedrich K, Schneider KTM, Hauner H, Bader BL. Effect of maternal obesity with and without gestational diabetes on offspring subcutaneous and preperitoneal adipose tissue development from birth up to year-1. BMC Pregnancy Childbirth. 2014;14:138.
Bochner CJ, Medearis AL, Williams J III, Castro L, Hobel CJ, Wade ME. Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term. Am J Obstet Gynecol. 1987;157(3):703-708.
Appleton K, Barnard JK, Jantz A, et al. The role of ultrasound in the diagnosis of complications associated with maternal diabetes. Ultrasound Obstet Gynecol. 2013;7(4):506-515.
Jazayeri A, Heffron JA, Phillips R, Spellacy WN. Macrosomia prediction using ultrasound fetal abdominal circumference of 35 centimeters or more. Obstet Gynecol. 1999;93(4):523-526.
Buchanan TA, Kjos SL, Schafer U, et al. Utility of fetal measurements in the management of gestational diabetes mellitus. Diabetes Care. 1998;21(Suppl 2):B99-B106.
Kjos SL, Schaefer-Graf U, Sardesi S, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care. 2001;24(11):1904-1910.
Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30(Suppl 2):S251-S260.
Barnes RA, Wong T, Ross GP, et al. A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus. Diabetologia. 2016;59(11):2331-2338.
Santos MJ, Fernandes V. Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test. Endocrine. 2018;62:602-610.
Schwärzler P, Bland JM, Holden D, Campbell S, Ville Y. Sex-specific antenatal reference growth charts for uncomplicated singleton pregnancies at 15-40 weeks of gestation. Ultrasound Obstet Gynecol. 2004;23(1):23-29.
Scifres CM, Feghali M, Dumont T, et al. Large-for-gestational-age ultrasound diagnosis and risk for cesarean delivery in women with gestational diabetes mellitus. Obstet Gynecol. 2015;126(5):978-986.
Rosen H, Shmueli A, Ashwal E, Hiersch L, Yogev Y, Aviram A. Delivery outcomes of large-for-gestational-age newborns stratified by the presence or absence of gestational diabetes mellitus. Int J Gynaecol Obstet. 2018;141(1):120-125.
Onal EE, Hirfanoglu IM, Beken S, et al. Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus? World J Pediatr. 2012;8(2):136-139.
Nankervis A, McIntyre HD, Moses RG, et al. ADIPS Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia (Modified November 2014). Sydney, Australia: Australasian Diabetes in Pregnancy Society (ADIPS); 2014. https://www.adips.org/downloads/2014ADIPSGDMGuidelinesV18.11.2014_000.pdf. Accessed January 9, 2019.
Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002.
Law GR, Alnaji A, Alrefaii L, et al. Suboptimal nocturnal glucose control is associated with large for gestational age in treated gestational diabetes mellitus. Diabetes Care. 2019;42(5):810-815.
Leopold H, Worda C, Gruber CJ, et al. Large-for-gestational-age newborns in women with insulin-treated gestational diabetes under strict metabolic control. Wien Klin Wochenschr. 2005;117(15-16):521-525.
Bogdanet D, Egan AM, Reddin C, et al. ATLANTIC DIP: insulin therapy for women with IADPSG-diagnosed gestational diabetes mellitus. Does it work? J Clin Endocrinol Metab. 2017;102(3):849-857.
Boriboonhirunsarn D, Kasempipatchai V. Incidence of large for gestational age infants when gestational diabetes mellitus is diagnosed early and late in pregnancy. J Obstet Gynaecol Res. 2016;42(3):273-278.
Berggren EK, Stuebe AM, Boggess KA. Excess maternal weight gain and large for gestational age risk among women with gestational diabetes. Am J Perinatol. 2015;32(3):251-256.
Barnes RA, Edghill N, Mackenzie J, et al. Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. Diabet Med. 2013;30(9):1040-1046.
Son G, Kwon J, Kwon JY, et al. Maternal serum triglycerides as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2010;89(5):700-704.
Gasiorowska A, Zawiejska A, Dydowicz P, et al. Maternal factors, ultrasound and placental function parameters in early pregnancy as predictors of birth weight in low-risk populations and among patients with pre-gestational diabetes. Ginekol pol. 2019;90(7):388-395.
Weiss PA, Hofmann HM, Kainer F, et al. Fetal outcome in gestational diabetes with elevated amniotic fluid insulin levels. Dietary versus insulin treatment. Diabetes Res Clin Pract. 1988;5(1):1-7.
Holzapfel-Bauer M, Magnet E, Eder M, Haas J, Desoye G, Lang U. Amniotic fluid insulin levels versus mean maternal blood glucose levels in gestational diabetes mellitus: an analysis of the neonatal outcome. Gynakol Geburtshilfliche Rundsch. 2009;49(4):249-253.
Hoffman L, Nolan C, Wilson JD, Oats JJN, Simmons D. Gestational diabetes mellitus-management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust. 1998;169(2):93-97.
Party GDMPW. SESLHD Gestational Diabetes Mellitus Management (GDM) Policy. 2014. https://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Women_Babies_Health/Documents/SESLHDPD282-FINALPolicy-GestationalDiabetesMellitus(GDM)Managem.pdf.
Sapienza AD, Francisco RP, Trindade TC, et al. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract. 2010;88(1):81-86.
Contreras KR, Kominiarek MA, Zollinger TW. The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes. J Perinatol. 2010;30(5):319-323.
Schaefer-Graf UM, Wendt L, Sacks DA, et al. How many sonograms are needed to reliably predict the absence of fetal overgrowth in gestational diabetes mellitus pregnancies? Diabetes Care. 2011;34(1):39-43.
Cremona A, Saunders J, Cotter A, Hamilton J, Donnelly AE, O'Gorman CS. Maternal obesity and degree of glucose intolerance on neonatal hypoglycaemia and birth weight: a retrospective observational cohort study in women with gestational diabetes mellitus. Eur J Paediatr. 2020;179(4):653-660.
Alberico S, Montico M, Barresi V, et al. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth. 2014;14(1):23.
Berntorp K, Anderberg E, Claesson R, Ignell C, Källén K. The relative importance of maternal body mass index and glucose levels for prediction of large-for-gestational-age births. BMC Pregnancy Childbirth. 2015;15(1):280.
Quevedo SF, Bovbjerg ML, Kington RL. Translation of fetal abdominal circumference-guided therapy of gestational diabetes complicated by maternal obesity to a clinical outpatient setting. J Matern Fetal Neonatal Med. 2017;30(12):1450-1455.
Rekawek P, Liu L, Getrajdman C, et al. Large-for-gestational age diagnosed during second-trimester anatomy ultrasound and association with gestational diabetes and large-for-gestational age at birth. Ultrasound Obstet Gynecol. 2019;25. https://doi.org/10.1002/uog.21930 [Epub ahead of print].
Barnes RA, Wong T, Ross GP, et al. Excessive weight gain before and during gestational diabetes mellitus management: what is the impact? Diabetes Care. 2019;43(1):74-81.
Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care. 2007;30(Supplement 2):S200-S205.
Shushan A, Ezra Y, Samueloff A. Early treatment of gestational diabetes reduces the rate of fetal macrosomia. Am J Perinatol. 1997;14(5):253-256.
Hiersch L, Yogev Y. Management of diabetes and pregnancy - when to start and what pharmacological agent to choose? Best Pract Res Clin Obstet Gynaecol. 2015;29(2):225-236.
Simmons D, Nema J, Parton C, et al. The treatment of booking gestational diabetes mellitus (TOBOGM) pilot randomised controlled trial. BMC Pregnancy Childbirth. 2018;18(1):151.
Hammoud NM, Visser GH, Peters SA, et al. Fetal growth profiles of macrosomic and non-macrosomic infants of women with pregestational or gestational diabetes. Ultrasound Obstet Gynecol. 2013;41(4):390-397.
Laafira A, White SW, Griffin CJ, Graham D. Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia. Aust N Z J Obstet Gynaecol. 2016;56(1):36-41.
Duran A, Sáenz S, Torrejón MJ, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care. 2014;37(9):2442-2450.
Mission JF, Ohno MS, Cheng YW, et al. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol. 2012;207(4):326.e321-326.e329.