Asymmetric Large-for-Gestational-Age Infants of Type 1 Diabetic Women: Morbidity and Abdominal Growth

Abstract

We sought to examine neonatal morbidity in four groups of offspring (asymmetric large for gestational age [LGA], symmetric LGA, asymmetric non-LGA, symmetric non-LGA) exposed in utero to maternal type 1 diabetes, and the association between rate of fetal abdominal circumference growth and asymmetric LGA. We performed a secondary analysis of 302 singleton pregnancies. Neonatal morbidity (respiratory distress syndrome, polycythemia, hypoglycemia, hyperbilirubinemia, acidosis, and composite morbidity [any of the five]) was assessed. Serial ultrasound examinations after 20 weeks' gestation were available for 35 fetuses. Logistic regression and general linear mixed modeling were used for analysis. Asymmetric LGA infants had 3.5-, 2.2-, and 3.2-fold greater odds of hypoglycemia, hyperbilirubinemia, and composite morbidity, respectively, compared with symmetric non-LGA infants. The rate of growth of the abdominal circumference in asymmetric LGA infants (1.11 cm/wk) was greater than for both the symmetric LGA infants (0.87 cm/wk, P = 0.09) and the symmetric non-LGA infants (0.87 cm/wk, P = 0.03). Asymmetric LGA infants are at higher risk for morbidity than symmetric LGA and non-LGA infants. Intrauterine growth rate of the abdominal circumference may potentially be used as a marker to identify the asymmetric LGA and thereby aid in the identification of newborns at greatest risk for perinatal complications.

Pregestational body mass index is related to neonatal abdominal circumference at birth—a Danish population‐based study

“…have shown that increasing maternal body mass index (BMI) is associated with increasing abdominal and intrahepatocellular lipid content in the neonatal offspring, measured by magnetic resonance spectroscopy. In fetal life, accelerated growth of the abdominal circumference (AC) is a predictor of asymmetric growth and neonatal morbidity . Moreover, Ruckinger et al .…”

“…In fetal life, accelerated growth of the abdominal circumference (AC) is a predictor of asymmetric growth and neonatal morbidity. 25 Moreover, Ruckinger et al 17 have shown that BMI at 5 years was associated with the abdominal diameter of the fetus, measured in utero by abdominal ultrasound at 33 and 37 weeks of gestation and in childhood. Current AC has been shown to be an independent predictor of insulin resistance.…”

Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies

“…Growth patterns of the AC throughout pregnancy have been shown to be altered for women with diabetes compared with normal controls 32 with AC measurements showing increased growth rate in large for gestational age (LGA) infants 4 33 , 34 Symmetry of the AC and HC measurements is also important with fetuses of diabetic mothers having an increased AC/HC ratio 32 . LGA infants with increased AC/HC ratio have a higher risk of neonatal morbidity and should be identified prior to delivery 34 .…”

“…, 33 , 34 Symmetry of the AC and HC measurements is also important with fetuses of diabetic mothers having an increased AC/HC ratio 32 . LGA infants with increased AC/HC ratio have a higher risk of neonatal morbidity and should be identified prior to delivery 34 . Rather than relying on the EFW as a standalone result, the AC and its ratio to the HC can provide extra information to women when counselling regarding delivery and risks of adverse outcomes such as shoulder dystocia.…”

“…32 LGA infants with increased AC/HC ratio have a higher risk of neonatal morbidity and should be identified prior to delivery. 34 Rather than relying on the EFW as a standalone result, the AC and its ratio to the HC can provide extra information to women when counselling regarding delivery and risks of adverse outcomes such as shoulder dystocia. Other work has shown that LGA offspring of gestational diabetic mothers have increased rates of obesity compared with those born at a normal weight.…”